Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.86 / $60.61 / $63.96	Professional		$51.86	$60.61	$63.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.19 / $22.60 / $23.78	Professional	26	$20.19	$22.60	$23.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.44 / $40.17 / $40.42	Professional	TC	$31.44	$40.17	$40.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.11 / $32.11 / $67.00	Professional		$32.11	$32.11	$67.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.52 / $11.52 / $24.03	Professional	26	$11.52	$11.52	$24.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.59 / $20.59 / $42.96	Professional	TC	$20.59	$20.59	$42.96
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $72.16 / $72.16 / $98.93	Professional		$72.16	$72.16	$98.93
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $28.02 / $28.02 / $39.85	Professional	26	$28.02	$28.02	$39.85
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $44.14 / $44.14 / $59.08	Professional	TC	$44.14	$44.14	$59.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.06 / $43.45 / $114.74	Professional		$29.06	$43.45	$114.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $13.99 / $40.40	Professional	26	$10.47	$13.99	$40.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.63 / $28.12 / $73.94	Professional	TC	$18.63	$28.12	$73.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $62.97 / $80.76 / $91.78	Professional		$62.97	$80.76	$91.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.57 / $28.17 / $33.00	Professional	26	$23.57	$28.17	$33.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.39 / $51.21 / $59.75	Professional	TC	$39.39	$51.21	$59.75
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $38.18 / $38.18 / $75.76	Facility	26	$38.18	$38.18	$75.76
Medcost Facility/Professional Professional Modifier Low / Median / High Price $35.00 / $63.00 / $132.18	Professional		$35.00	$63.00	$132.18
Sentara Facility/Professional Professional Modifier Low / Median / High Price $31.20 / $76.56 / $138.38	Professional		$31.20	$76.56	$138.38
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $24.09 / $31.50 / $56.78	Professional	26	$24.09	$31.50	$56.78
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $32.76 / $61.78 / $102.17	Professional	TC	$32.76	$61.78	$102.17
United Facility/Professional Professional Modifier Low / Median / High Price $44.73 / $74.55 / $123.77	Professional		$44.73	$74.55	$123.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.72 / $27.47 / $43.70	Professional	26	$14.72	$27.47	$43.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.11 / $46.85 / $83.42	Professional	TC	$28.11	$46.85	$83.42