Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $89.13 / $363.08	Professional		$63.10	$89.13	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $61.66 / $213.80	Professional	26	$25.70	$61.66	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $60.26 / $173.78	Professional	TC	$43.65	$60.26	$173.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $44.67 / $95.50	Professional		$44.67	$44.67	$95.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $16.22 / $42.66	Professional	26	$16.22	$16.22	$42.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $29.51 / $61.66	Professional	TC	$29.51	$29.51	$61.66
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $93.33 / $128.82	Professional		$30.90	$93.33	$128.82
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $36.31 / $36.31	Professional	26	$36.31	$36.31	$36.31
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $83.18 / $87.10	Professional	TC	$79.43	$83.18	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $63.10 / $177.83	Professional		$46.77	$63.10	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $23.44 / $72.44	Professional	26	$15.85	$23.44	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $40.74 / $117.49	Professional	TC	$26.92	$40.74	$117.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $141.25 / $158.49	Professional		$109.65	$141.25	$158.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $38.90 / $45.71	Professional	26	$32.36	$38.90	$45.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $100.00 / $114.82	Professional	TC	$75.86	$100.00	$114.82
Medcost Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $128.82 / $204.17	Facility		$87.10	$128.82	$204.17
Medcost Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $45.71 / $45.71	Professional		$45.71	$45.71	$45.71
Sentara Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $85.11 / $169.82	Facility		$45.71	$85.11	$169.82
Sentara Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $114.82 / $208.93	Professional		$52.48	$114.82	$208.93
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $56.23 / $79.43	Professional	26	$42.66	$56.23	$79.43
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $87.10 / $154.88	Professional	TC	$45.71	$87.10	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $107.15 / $213.80	Professional		$63.10	$107.15	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $37.15 / $77.62	Professional	26	$21.88	$37.15	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $66.07 / $138.04	Professional	TC	$31.62	$66.07	$138.04