Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.88 / $88.72 / $173.89	Professional		$77.88	$88.72	$173.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.77 / $61.77 / $755.41	Professional	26	$50.77	$61.77	$755.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.07 / $37.96 / $70.09	Professional	TC	$28.07	$37.96	$70.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.89 / $39.89 / $91.56	Professional		$39.89	$39.89	$91.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.64 / $26.64 / $61.84	Professional	26	$26.64	$26.64	$61.84
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $13.48 / $13.48 / $28.13	Professional	TC	$13.48	$13.48	$28.13
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $107.62 / $107.62 / $131.33	Professional		$107.62	$107.62	$131.33
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $69.11 / $69.11 / $93.29	Professional	26	$69.11	$69.11	$93.29
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $38.51 / $38.51 / $45.06	Professional	TC	$38.51	$38.51	$45.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.47 / $60.06 / $168.25	Professional		$43.47	$60.06	$168.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.94 / $36.24 / $116.90	Professional	26	$27.94	$36.24	$116.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.83 / $23.02 / $68.63	Professional	TC	$14.83	$23.02	$68.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $96.59 / $125.57 / $157.24	Professional		$96.59	$125.57	$157.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.84 / $75.19 / $96.74	Professional	26	$57.84	$75.19	$96.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.76 / $51.73 / $60.52	Professional	TC	$38.76	$51.73	$60.52
Medcost Facility/Professional Facility Modifier Low / Median / High Price $85.60 / $127.00 / $192.75	Facility		$85.60	$127.00	$192.75
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $98.00 / $116.12 / $191.00	Facility	26	$98.00	$116.12	$191.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $63.84 / $63.84 / $90.32	Facility	TC	$63.84	$63.84	$90.32
Medcost Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $94.00 / $158.09	Professional		$40.00	$94.00	$158.09
Sentara Facility/Professional Facility Modifier Low / Median / High Price $36.67 / $91.15 / $159.85	Facility		$36.67	$91.15	$159.85
Sentara Facility/Professional Professional Modifier Low / Median / High Price $47.83 / $113.05 / $193.77	Professional		$47.83	$113.05	$193.77
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $64.08 / $89.23 / $135.47	Professional	26	$64.08	$89.23	$135.47
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $33.17 / $50.96 / $91.30	Professional	TC	$33.17	$50.96	$91.30
United Facility/Professional Professional Modifier Low / Median / High Price $59.83 / $99.72 / $166.78	Professional		$59.83	$99.72	$166.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.04 / $65.06 / $119.62	Professional	26	$39.04	$65.06	$119.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.61 / $32.67 / $56.56	Professional	TC	$17.61	$32.67	$56.56