Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.16 / $153.09 / $235.55	Professional		$92.16	$153.09	$235.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.03 / $21.32 / $22.25	Professional	26	$19.03	$21.32	$22.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.99 / $134.05 / $164.47	Professional	TC	$108.99	$134.05	$164.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.54 / $64.54 / $134.68	Professional		$64.54	$64.54	$134.68
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.29 / $20.29 / $42.34	Professional	26	$20.29	$20.29	$42.34
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.25 / $44.25 / $92.34	Professional	TC	$44.25	$44.25	$92.34
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $202.38 / $202.38 / $236.78	Professional		$202.38	$202.38	$236.78
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $26.20 / $26.20 / $36.36	Professional	26	$26.20	$26.20	$36.36
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $176.18 / $176.18 / $206.13	Professional	TC	$176.18	$176.18	$206.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.77 / $122.42 / $327.64	Professional		$69.77	$122.42	$327.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.55 / $21.60 / $66.59	Professional	26	$10.55	$21.60	$66.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.75 / $107.99 / $279.38	Professional	TC	$51.75	$107.99	$279.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $185.50 / $244.67 / $280.82	Professional		$185.50	$244.67	$280.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $28.44 / $45.41	Professional	26	$21.88	$28.44	$45.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $163.62 / $212.71 / $248.18	Professional	TC	$163.62	$212.71	$248.18
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $47.25 / $67.98 / $135.86	Facility	26	$47.25	$67.98	$135.86
Medcost Facility/Professional Professional Modifier Low / Median / High Price $33.00 / $149.00 / $322.00	Professional		$33.00	$149.00	$322.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $68.98 / $236.57 / $399.93	Professional		$68.98	$236.57	$399.93
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $33.95 / $53.71 / $69.51	Professional	26	$33.95	$53.71	$69.51
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $126.71 / $228.60 / $389.33	Professional	TC	$126.71	$228.60	$389.33
United Facility/Professional Professional Modifier Low / Median / High Price $108.82 / $178.58 / $365.94	Professional		$108.82	$178.58	$365.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.53 / $35.15 / $77.14	Professional	26	$15.53	$35.15	$77.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.69 / $141.49 / $279.86	Professional	TC	$91.69	$141.49	$279.86