Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.79 / $79.34 / $160.57	Professional		$53.79	$79.34	$160.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.06 / $43.35 / $237.76	Professional	26	$23.06	$43.35	$237.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.00 / $56.98 / $176.76	Professional	TC	$42.00	$56.98	$176.76
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.86 / $37.86 / $79.02	Professional		$37.86	$37.86	$79.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.95 / $11.95 / $24.93	Professional	26	$11.95	$11.95	$24.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.92 / $25.92 / $54.08	Professional	TC	$25.92	$25.92	$54.08
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $88.25 / $88.25 / $116.03	Professional		$88.25	$88.25	$116.03
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $31.14 / $31.14 / $41.66	Professional	26	$31.14	$31.14	$41.66
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $57.11 / $57.11 / $74.37	Professional	TC	$57.11	$57.11	$74.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.25 / $52.18 / $152.75	Professional		$33.25	$52.18	$152.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.82 / $15.38 / $45.38	Professional	26	$10.82	$15.38	$45.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.43 / $36.00 / $104.59	Professional	TC	$22.43	$36.00	$104.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $92.24 / $119.88 / $136.22	Professional		$92.24	$119.88	$136.22
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.35 / $32.08 / $36.89	Professional	26	$26.35	$32.08	$36.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $65.89 / $85.66 / $99.76	Professional	TC	$65.89	$85.66	$99.76
Medcost Facility/Professional Facility Modifier Low / Median / High Price $80.67 / $109.50 / $170.60	Facility		$80.67	$109.50	$170.60
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $31.92 / $31.92 / $80.26	Facility	26	$31.92	$31.92	$80.26
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $63.75 / $63.75 / $167.02	Facility	TC	$63.75	$63.75	$167.02
Medcost Facility/Professional Professional Modifier Low / Median / High Price $36.00 / $77.00 / $169.00	Professional		$36.00	$77.00	$169.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $28.13 / $68.51 / $141.21	Facility		$28.13	$68.51	$141.21
Sentara Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $87.22 / $173.55	Professional		$32.36	$87.22	$173.55
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $24.89 / $34.61 / $62.07	Professional	26	$24.89	$34.61	$62.07
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $51.67 / $71.92 / $141.21	Professional	TC	$51.67	$71.92	$141.21
United Facility/Professional Professional Modifier Low / Median / High Price $51.64 / $93.50 / $168.30	Professional		$51.64	$93.50	$168.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.34 / $29.48 / $48.18	Professional	26	$15.34	$29.48	$48.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.29 / $64.02 / $103.36	Professional	TC	$36.29	$64.02	$103.36