Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.97 / $93.29 / $101.67	Professional		$83.97	$93.29	$101.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.66 / $29.19 / $30.49	Professional	26	$26.66	$29.19	$30.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.04 / $64.97 / $74.67	Professional	TC	$58.04	$64.97	$74.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.65 / $105.65 / $220.47	Professional		$105.65	$105.65	$220.47
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.10 / $24.10 / $50.29	Professional	26	$24.10	$24.10	$50.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.56 / $81.56 / $170.19	Professional	TC	$81.56	$81.56	$170.19
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $112.32 / $112.32 / $134.22	Professional		$112.32	$112.32	$134.22
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $36.90 / $36.90 / $50.33	Professional	26	$36.90	$36.90	$50.33
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $75.41 / $75.41 / $88.23	Professional	TC	$75.41	$75.41	$88.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.80 / $97.91 / $258.57	Professional		$50.80	$97.91	$258.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.90 / $29.58 / $87.49	Professional	26	$14.90	$29.58	$87.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.99 / $68.15 / $193.23	Professional	TC	$34.99	$68.15	$193.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.28 / $135.56 / $233.45	Professional		$104.28	$135.56	$233.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.91 / $40.18 / $64.26	Professional	26	$30.91	$40.18	$64.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.38 / $97.96 / $169.20	Professional	TC	$73.38	$97.96	$169.20
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $64.18 / $97.33 / $143.86	Facility	26	$64.18	$97.33	$143.86
Medcost Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $118.00 / $353.00	Professional		$45.00	$118.00	$353.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $88.24 / $211.60 / $328.72	Professional		$88.24	$211.60	$328.72
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $46.40 / $66.11 / $89.90	Professional	26	$46.40	$66.11	$89.90
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $112.02 / $175.55 / $250.17	Professional	TC	$112.02	$175.55	$250.17
United Facility/Professional Professional Modifier Low / Median / High Price $68.56 / $148.34 / $359.05	Professional		$68.56	$148.34	$359.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.37 / $47.59 / $90.29	Professional	26	$21.37	$47.59	$90.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.19 / $100.75 / $190.96	Professional	TC	$47.19	$100.75	$190.96