Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $57.54 / $104.71	Professional		$46.77	$57.54	$104.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.95 / $38.90	Professional	26	$15.14	$19.95	$38.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $38.02 / $67.61	Professional	TC	$30.90	$38.02	$67.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $67.61	Professional		$32.36	$32.36	$67.61
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $11.48 / $23.99	Professional	26	$11.48	$11.48	$23.99
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $20.42 / $42.66	Professional	TC	$20.42	$20.42	$42.66
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $45.71 / $74.13	Professional		$23.44	$45.71	$74.13
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $22.39 / $24.55	Professional	26	$22.39	$22.39	$24.55
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $48.98 / $48.98	Professional	TC	$48.98	$48.98	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $43.65 / $114.82	Professional		$28.84	$43.65	$114.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $14.13 / $40.74	Professional	26	$10.47	$14.13	$40.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $28.84 / $75.86	Professional	TC	$18.62	$28.84	$75.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $79.43 / $91.20	Professional		$63.10	$79.43	$91.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $28.18 / $33.11	Professional	26	$23.44	$28.18	$33.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $50.12 / $58.88	Professional	TC	$38.90	$50.12	$58.88
Medcost Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $20.42 / $20.42	Professional		$20.42	$20.42	$20.42
Sentara Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $75.86 / $138.04	Professional		$30.90	$75.86	$138.04
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $31.62 / $56.23	Professional	26	$23.99	$31.62	$56.23
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $57.54 / $102.33	Professional	TC	$44.67	$57.54	$102.33
United Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $74.13 / $147.91	Professional		$44.67	$74.13	$147.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $27.54 / $50.12	Professional	26	$14.79	$27.54	$50.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $46.77 / $95.50	Professional	TC	$28.18	$46.77	$95.50