Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.19 / $136.81 / $210.00	Professional		$92.19	$136.81	$210.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $31.17 / $62.45	Professional	26	$17.05	$31.17	$62.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.49 / $84.34 / $127.84	Professional	TC	$51.49	$84.34	$127.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.39 / $41.39 / $86.37	Professional		$41.39	$41.39	$86.37
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $16.48 / $34.39	Professional	26	$16.48	$16.48	$34.39
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.92 / $24.92 / $52.00	Professional	TC	$24.92	$24.92	$52.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $150.86 / $150.86 / $176.51	Professional		$150.86	$150.86	$176.51
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $39.84 / $39.84 / $52.46	Professional	26	$39.84	$39.84	$52.46
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $111.02 / $111.02 / $129.88	Professional	TC	$111.02	$111.02	$129.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.35 / $87.11 / $229.10	Professional		$47.35	$87.11	$229.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.19 / $22.89 / $76.02	Professional	26	$16.19	$22.89	$76.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.44 / $56.59 / $161.88	Professional	TC	$28.44	$56.59	$161.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.03 / $179.44 / $204.63	Professional		$138.03	$179.44	$204.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.46 / $43.50 / $67.44	Professional	26	$33.46	$43.50	$67.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.57 / $135.94 / $158.55	Professional	TC	$104.57	$135.94	$158.55
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $71.00 / $78.92 / $111.00	Facility	26	$71.00	$78.92	$111.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $47.00 / $93.00 / $214.00	Professional		$47.00	$93.00	$214.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $61.33 / $131.18 / $291.42	Professional		$61.33	$131.18	$291.42
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $42.68 / $55.00 / $78.75	Professional	26	$42.68	$55.00	$78.75
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $63.76 / $132.47 / $237.03	Professional	TC	$63.76	$132.47	$237.03
United Facility/Professional Professional Modifier Low / Median / High Price $66.17 / $123.99 / $205.57	Professional		$66.17	$123.99	$205.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.44 / $37.63 / $75.06	Professional	26	$22.44	$37.63	$75.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.81 / $64.51 / $145.52	Professional	TC	$34.81	$64.51	$145.52