Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.13 / $202.91 / $613.71	Professional		$173.13	$202.91	$613.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.53 / $110.70 / $112.22	Professional	26	$99.53	$110.70	$112.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.78 / $84.87 / $103.38	Professional	TC	$81.78	$84.87	$103.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.06 / $109.06 / $227.58	Professional		$109.06	$109.06	$227.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.84 / $51.84 / $108.17	Professional	26	$51.84	$51.84	$108.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.27 / $58.27 / $121.59	Professional	TC	$58.27	$58.27	$121.59
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $253.39 / $253.39 / $296.47	Professional		$253.39	$253.39	$296.47
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $142.01 / $142.01 / $177.98	Professional	26	$142.01	$142.01	$177.98
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $111.38 / $111.38 / $130.31	Professional	TC	$111.38	$111.38	$130.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.54 / $150.32 / $395.73	Professional		$104.54	$150.32	$395.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.96 / $74.41 / $239.77	Professional	26	$54.96	$74.41	$239.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.07 / $71.30 / $191.69	Professional	TC	$47.07	$71.30	$191.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $226.53 / $294.49 / $466.34	Professional		$226.53	$294.49	$466.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $113.91 / $147.41 / $204.69	Professional	26	$113.91	$147.41	$204.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.62 / $150.52 / $260.00	Professional	TC	$112.62	$150.52	$260.00
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $209.00 / $223.24 / $364.96	Facility	26	$209.00	$223.24	$364.96
Medcost Facility/Professional Professional Modifier Low / Median / High Price $117.77 / $236.00 / $459.99	Professional		$117.77	$236.00	$459.99
Sentara Facility/Professional Professional Modifier Low / Median / High Price $157.81 / $333.64 / $466.43	Professional		$157.81	$333.64	$466.43
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $146.79 / $186.02 / $282.42	Professional	26	$146.79	$186.02	$282.42
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $154.75 / $180.60 / $245.86	Professional	TC	$154.75	$180.60	$245.86
United Facility/Professional Professional Modifier Low / Median / High Price $143.27 / $238.79 / $455.16	Professional		$143.27	$238.79	$455.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.06 / $133.44 / $261.76	Professional	26	$80.06	$133.44	$261.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.21 / $106.47 / $212.94	Professional	TC	$63.21	$106.47	$212.94