Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.34 / $104.80 / $121.57	Professional		$73.34	$104.80	$121.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.75 / $40.22 / $109.87	Professional	26	$32.75	$40.22	$109.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.96 / $72.47 / $163.40	Professional	TC	$53.96	$72.47	$163.40
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.59 / $60.59 / $136.66	Professional		$60.59	$60.59	$136.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.33 / $22.33 / $50.36	Professional	26	$22.33	$22.33	$50.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.46 / $39.46 / $87.67	Professional	TC	$39.46	$39.46	$87.67
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $125.63 / $125.63 / $172.00	Professional		$125.63	$125.63	$172.00
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $47.93 / $47.93 / $58.76	Professional	26	$47.93	$47.93	$58.76
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $77.70 / $77.70 / $113.23	Professional	TC	$77.70	$77.70	$113.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.05 / $87.03 / $230.51	Professional		$57.05	$87.03	$230.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.55 / $30.61 / $94.65	Professional	26	$19.55	$30.61	$94.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.50 / $55.99 / $143.52	Professional	TC	$37.50	$55.99	$143.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $110.85 / $144.11 / $246.30	Professional		$110.85	$144.11	$246.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.27 / $52.35 / $83.68	Professional	26	$40.27	$52.35	$83.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.59 / $94.15 / $162.62	Professional	TC	$70.59	$94.15	$162.62
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $108.71 / $126.85 / $151.00	Facility	26	$108.71	$126.85	$151.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $76.00 / $136.00 / $245.00	Professional		$76.00	$136.00	$245.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $74.64 / $181.09 / $238.44	Professional		$74.64	$181.09	$238.44
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $57.07 / $72.04 / $95.43	Professional	26	$57.07	$72.04	$95.43
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $103.51 / $122.63 / $179.70	Professional	TC	$103.51	$122.63	$179.70
United Facility/Professional Professional Modifier Low / Median / High Price $76.97 / $132.58 / $266.49	Professional		$76.97	$132.58	$266.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.85 / $46.80 / $95.14	Professional	26	$27.85	$46.80	$95.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.12 / $81.87 / $170.59	Professional	TC	$49.12	$81.87	$170.59