Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $126.79 / $151.50 / $415.00	Professional		$126.79	$151.50	$415.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.98 / $34.11 / $70.09	Professional	26	$29.98	$34.11	$70.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.56 / $120.34 / $453.33	Professional	TC	$93.56	$120.34	$453.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $71.42 / $71.42 / $149.03	Professional		$71.42	$71.42	$149.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.42 / $16.42 / $34.26	Professional	26	$16.42	$16.42	$34.26
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.01 / $55.01 / $114.79	Professional	TC	$55.01	$55.01	$114.79
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $167.35 / $167.35 / $215.09	Professional		$167.35	$167.35	$215.09
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $42.22 / $42.22 / $57.23	Professional	26	$42.22	$42.22	$57.23
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $125.13 / $125.13 / $157.86	Professional	TC	$125.13	$125.13	$157.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.60 / $101.00 / $291.12	Professional		$57.60	$101.00	$291.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.29 / $22.50 / $65.63	Professional	26	$17.29	$22.50	$65.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.70 / $80.22 / $219.07	Professional	TC	$37.70	$80.22	$219.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $164.86 / $214.32 / $244.95	Professional		$164.86	$214.32	$244.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.02 / $43.79 / $50.43	Professional	26	$36.02	$43.79	$50.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.83 / $167.48 / $195.19	Professional	TC	$128.83	$167.48	$195.19
Medcost Facility/Professional Facility Modifier Low / Median / High Price $146.44 / $198.13 / $415.00	Facility		$146.44	$198.13	$415.00
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $58.66 / $58.66 / $108.81	Facility	26	$58.66	$58.66	$108.81
Medcost Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $165.00 / $320.54	Professional		$50.00	$165.00	$320.54
Sentara Facility/Professional Facility Modifier Low / Median / High Price $49.73 / $113.20 / $302.70	Facility		$49.73	$113.20	$302.70
Sentara Facility/Professional Professional Modifier Low / Median / High Price $59.27 / $151.03 / $323.41	Professional		$59.27	$151.03	$323.41
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $45.75 / $55.05 / $83.29	Professional	26	$45.75	$55.05	$83.29
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $86.84 / $134.06 / $308.80	Professional	TC	$86.84	$134.06	$308.80
United Facility/Professional Professional Modifier Low / Median / High Price $89.26 / $166.58 / $313.20	Professional		$89.26	$166.58	$313.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.95 / $39.92 / $75.31	Professional	26	$23.95	$39.92	$75.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.04 / $113.03 / $216.54	Professional	TC	$61.04	$113.03	$216.54