Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.35 / $87.07 / $176.96	Professional		$63.35	$87.07	$176.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.36 / $37.83 / $92.56	Professional	26	$28.36	$37.83	$92.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.27 / $59.78 / $124.41	Professional	TC	$35.27	$59.78	$124.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.64 / $44.64 / $93.83	Professional		$44.64	$44.64	$93.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.34 / $16.34 / $38.15	Professional	26	$16.34	$16.34	$38.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.66 / $29.66 / $61.89	Professional	TC	$29.66	$29.66	$61.89
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $105.42 / $105.42 / $137.36	Professional		$105.42	$105.42	$137.36
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $38.38 / $38.38 / $52.22	Professional	26	$38.38	$38.38	$52.22
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $67.04 / $67.04 / $85.14	Professional	TC	$67.04	$67.04	$85.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.92 / $63.35 / $173.81	Professional		$46.92	$63.35	$173.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.74 / $22.85 / $72.01	Professional	26	$15.74	$22.85	$72.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.74 / $40.52 / $113.89	Professional	TC	$26.74	$40.52	$113.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.52 / $139.78 / $183.02	Professional		$107.52	$139.78	$183.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.47 / $42.22 / $66.81	Professional	26	$32.47	$42.22	$66.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.04 / $100.09 / $116.18	Professional	TC	$75.04	$100.09	$116.18
Medcost Facility/Professional Facility Modifier Low / Median / High Price $89.14 / $134.21 / $218.16	Facility		$89.14	$134.21	$218.16
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $56.00 / $65.88 / $137.00	Facility	26	$56.00	$65.88	$137.00
Medcost Facility/Professional Facility Modifier TC Low / Median / High Price $126.00 / $126.00 / $181.78	Facility	TC	$126.00	$126.00	$181.78
Medcost Facility/Professional Professional Modifier Low / Median / High Price $46.00 / $94.00 / $180.00	Professional		$46.00	$94.00	$180.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $46.56 / $85.24 / $163.12	Facility		$46.56	$85.24	$163.12
Sentara Facility/Professional Professional Modifier Low / Median / High Price $52.26 / $114.83 / $197.74	Professional		$52.26	$114.83	$197.74
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $42.33 / $53.94 / $79.40	Professional	26	$42.33	$53.94	$79.40
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $51.64 / $96.33 / $155.16	Professional	TC	$51.64	$96.33	$155.16
United Facility/Professional Professional Modifier Low / Median / High Price $62.81 / $100.33 / $191.50	Professional		$62.81	$100.33	$191.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $36.81 / $74.17	Professional	26	$22.01	$36.81	$74.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.69 / $65.70 / $112.60	Professional	TC	$31.69	$65.70	$112.60