Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.78 / $108.74 / $148.08	Professional		$103.78	$108.74	$148.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.61 / $36.88 / $44.99	Professional	26	$32.61	$36.88	$44.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.86 / $72.64 / $103.06	Professional	TC	$71.86	$72.64	$103.06
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $88.50 / $88.50 / $184.68	Professional		$88.50	$88.50	$184.68
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.51 / $24.51 / $51.14	Professional	26	$24.51	$24.51	$51.14
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.99 / $63.99 / $133.53	Professional	TC	$63.99	$63.99	$133.53
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $135.24 / $135.24 / $158.22	Professional		$135.24	$135.24	$158.22
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $45.38 / $45.38 / $60.27	Professional	26	$45.38	$45.38	$60.27
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $89.86 / $89.86 / $105.14	Professional	TC	$89.86	$89.86	$105.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.68 / $99.20 / $251.27	Professional		$62.68	$99.20	$251.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.97 / $31.73 / $92.72	Professional	26	$18.97	$31.73	$92.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.18 / $71.88 / $183.20	Professional	TC	$38.18	$71.88	$183.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $142.57 / $185.34 / $320.11	Professional		$142.57	$185.34	$320.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.59 / $51.47 / $82.78	Professional	26	$39.59	$51.47	$82.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.98 / $137.40 / $237.33	Professional	TC	$102.98	$137.40	$237.33
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $74.70 / $117.98 / $151.69	Facility	26	$74.70	$117.98	$151.69
Medcost Facility/Professional Professional Modifier Low / Median / High Price $53.00 / $122.00 / $323.00	Professional		$53.00	$122.00	$323.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $82.96 / $214.95 / $308.75	Professional		$82.96	$214.95	$308.75
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $56.92 / $76.16 / $100.32	Professional	26	$56.92	$76.16	$100.32
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $130.04 / $166.52 / $221.61	Professional	TC	$130.04	$166.52	$221.61
United Facility/Professional Professional Modifier Low / Median / High Price $79.73 / $145.43 / $276.88	Professional		$79.73	$145.43	$276.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.90 / $51.69 / $98.01	Professional	26	$25.90	$51.69	$98.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.42 / $90.58 / $169.95	Professional	TC	$52.42	$90.58	$169.95