Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.59 / $80.34 / $181.33	Professional		$71.59	$80.34	$181.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.37 / $55.41 / $122.09	Professional	26	$48.37	$55.41	$122.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.42 / $29.62 / $63.42	Professional	TC	$21.42	$29.62	$63.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.79 / $38.79 / $85.40	Professional		$38.79	$38.79	$85.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.64 / $26.64 / $60.08	Professional	26	$26.64	$26.64	$60.08
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $14.84 / $14.84 / $30.96	Professional	TC	$14.84	$14.84	$30.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $99.11 / $99.11 / $122.16	Professional		$99.11	$99.11	$122.16
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $68.62 / $68.62 / $93.22	Professional	26	$68.62	$68.62	$93.22
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $30.49 / $30.49 / $35.67	Professional	TC	$30.49	$30.49	$35.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.92 / $58.01 / $152.65	Professional		$41.92	$58.01	$152.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.77 / $36.42 / $107.64	Professional	26	$27.77	$36.42	$107.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.60 / $20.93 / $52.58	Professional	TC	$12.60	$20.93	$52.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.37 / $113.58 / $165.02	Professional		$87.37	$113.58	$165.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.52 / $74.78 / $98.38	Professional	26	$57.52	$74.78	$98.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.85 / $39.86 / $66.63	Professional	TC	$29.85	$39.86	$66.63
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $116.68 / $132.00 / $176.97	Facility	26	$116.68	$132.00	$176.97
Medcost Facility/Professional Professional Modifier Low / Median / High Price $36.00 / $93.00 / $165.00	Professional		$36.00	$93.00	$165.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $46.29 / $120.11 / $176.93	Professional		$46.29	$120.11	$176.93
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $68.48 / $88.93 / $135.47	Professional	26	$68.48	$88.93	$135.47
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $23.95 / $46.22 / $73.18	Professional	TC	$23.95	$46.22	$73.18
United Facility/Professional Professional Modifier Low / Median / High Price $54.89 / $92.03 / $164.68	Professional		$54.89	$92.03	$164.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.04 / $65.06 / $117.11	Professional	26	$39.04	$65.06	$117.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $26.71 / $50.67	Professional	TC	$15.85	$26.71	$50.67