Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.36 / $96.95 / $198.37	Professional		$82.36	$96.95	$198.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.68 / $77.13 / $145.60	Professional	26	$68.68	$77.13	$145.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.12 / $22.63 / $52.77	Professional	TC	$20.12	$22.63	$52.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.87 / $54.87 / $114.50	Professional		$54.87	$54.87	$114.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.58 / $36.58 / $76.33	Professional	26	$36.58	$36.58	$76.33
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.33 / $22.33 / $46.59	Professional	TC	$22.33	$22.33	$46.59
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $122.93 / $122.93 / $165.06	Professional		$122.93	$122.93	$165.06
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $95.88 / $95.88 / $126.62	Professional	26	$95.88	$95.88	$126.62
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $27.05 / $27.05 / $38.44	Professional	TC	$27.05	$27.05	$38.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.16 / $77.86 / $212.47	Professional		$53.16	$77.86	$212.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.01 / $49.14 / $147.58	Professional	26	$39.01	$49.14	$147.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.86 / $26.56 / $70.26	Professional	TC	$12.86	$26.56	$70.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $111.61 / $145.09 / $232.40	Professional		$111.61	$145.09	$232.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.04 / $107.95 / $132.12	Professional	26	$83.04	$107.95	$132.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.57 / $38.15 / $65.91	Professional	TC	$28.57	$38.15	$65.91
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $113.00 / $162.04 / $247.64	Facility	26	$113.00	$162.04	$247.64
Medcost Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $121.00 / $225.46	Professional		$50.00	$121.00	$225.46
Sentara Facility/Professional Professional Modifier Low / Median / High Price $68.64 / $169.14 / $218.06	Professional		$68.64	$169.14	$218.06
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $91.68 / $124.53 / $190.08	Professional	26	$91.68	$124.53	$190.08
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $37.03 / $58.83 / $77.25	Professional	TC	$37.03	$58.83	$77.25
United Facility/Professional Professional Modifier Low / Median / High Price $70.25 / $120.13 / $228.43	Professional		$70.25	$120.13	$228.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.43 / $87.38 / $145.08	Professional	26	$49.43	$87.38	$145.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $34.81 / $80.87	Professional	TC	$15.85	$34.81	$80.87