Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.88 / $72.84 / $199.74	Professional		$51.88	$72.84	$199.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.32 / $63.00 / $216.60	Professional	26	$30.32	$63.00	$216.60
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $26.93 / $29.58 / $42.98	Professional	52	$26.93	$29.58	$42.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $35.21 / $100.93	Professional	TC	$26.62	$35.21	$100.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.91 / $67.91 / $141.71	Professional		$67.91	$67.91	$141.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.97 / $31.65 / $95.21	Professional	26	$28.97	$31.65	$95.21
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.11 / $36.40 / $75.98	Professional	TC	$32.11	$36.40	$75.98
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $71.44 / $71.44 / $90.45	Professional		$71.44	$71.44	$90.45
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $41.49 / $41.49 / $55.71	Professional	26	$41.49	$41.49	$55.71
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $29.95 / $29.95 / $35.04	Professional	TC	$29.95	$29.95	$35.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.17 / $54.88 / $145.66	Professional		$33.17	$54.88	$145.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.82 / $21.43 / $73.55	Professional	26	$16.82	$21.43	$73.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.05 / $25.80 / $73.73	Professional	TC	$15.05	$25.80	$73.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $68.72 / $89.34 / $151.26	Professional		$68.72	$89.34	$151.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.74 / $45.16 / $59.10	Professional	26	$34.74	$45.16	$59.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.97 / $45.38 / $78.38	Professional	TC	$33.97	$45.38	$78.38
Medcost Facility/Professional Facility Modifier Low / Median / High Price $69.20 / $97.43 / $189.68	Facility		$69.20	$97.43	$189.68
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $70.41 / $86.59 / $150.00	Facility	26	$70.41	$86.59	$150.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $82.87 / $82.87 / $147.12	Facility	TC	$82.87	$82.87	$147.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $37.00 / $72.00 / $142.00	Professional		$37.00	$72.00	$142.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $41.76 / $73.18 / $136.29	Facility		$41.76	$73.18	$136.29
Sentara Facility/Professional Professional Modifier Low / Median / High Price $52.68 / $106.50 / $155.61	Professional		$52.68	$106.50	$155.61
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $38.74 / $55.40 / $81.77	Professional	26	$38.74	$55.40	$81.77
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $46.05 / $67.15 / $96.80	Professional	TC	$46.05	$67.15	$96.80
United Facility/Professional Professional Modifier Low / Median / High Price $42.59 / $73.63 / $145.35	Professional		$42.59	$73.63	$145.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.52 / $39.20 / $76.33	Professional	26	$23.52	$39.20	$76.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.07 / $37.90 / $84.79	Professional	TC	$19.07	$37.90	$84.79