Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.93 / $81.63 / $184.46	Professional		$54.93	$81.63	$184.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.09 / $36.61 / $109.31	Professional	26	$20.09	$36.61	$109.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.43 / $79.61 / $146.30	Professional	TC	$44.43	$79.61	$146.30
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.74 / $39.74 / $83.53	Professional		$39.74	$39.74	$83.53
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $11.23 / $23.71	Professional	26	$11.23	$11.23	$23.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $28.51 / $59.49	Professional	TC	$28.51	$28.51	$59.49
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $100.04 / $100.04 / $120.88	Professional		$100.04	$100.04	$120.88
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $29.13 / $29.13 / $39.04	Professional	26	$29.13	$29.13	$39.04
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $70.91 / $70.91 / $82.96	Professional	TC	$70.91	$70.91	$82.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.35 / $67.47 / $183.46	Professional		$45.35	$67.47	$183.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.00 / $15.57 / $49.74	Professional	26	$12.00	$15.57	$49.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $48.67 / $141.33	Professional	TC	$32.79	$48.67	$141.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $106.72 / $139.46 / $164.02	Professional		$106.72	$139.46	$164.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.75 / $32.18 / $42.34	Professional	26	$24.75	$32.18	$42.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.97 / $109.41 / $124.33	Professional	TC	$81.97	$109.41	$124.33
Medcost Facility/Professional Facility Modifier Low / Median / High Price $76.00 / $124.51 / $193.80	Facility		$76.00	$124.51	$193.80
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $26.00 / $50.38 / $75.48	Facility	26	$26.00	$50.38	$75.48
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $158.28 / $158.28 / $205.11	Facility	TC	$158.28	$158.28	$205.11
Medcost Facility/Professional Professional Modifier Low / Median / High Price $35.00 / $98.00 / $187.00	Professional		$35.00	$98.00	$187.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $32.81 / $88.90 / $186.45	Facility		$32.81	$88.90	$186.45
Sentara Facility/Professional Professional Modifier Low / Median / High Price $39.38 / $120.21 / $210.90	Professional		$39.38	$120.21	$210.90
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $27.64 / $38.82 / $58.28	Professional	26	$27.64	$38.82	$58.28
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $69.23 / $115.63 / $186.45	Professional	TC	$69.23	$115.63	$186.45
United Facility/Professional Professional Modifier Low / Median / High Price $56.70 / $96.76 / $190.29	Professional		$56.70	$96.76	$190.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.61 / $27.68 / $54.28	Professional	26	$16.61	$27.68	$54.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.88 / $71.56 / $130.03	Professional	TC	$36.88	$71.56	$130.03