Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.08 / $72.66 / $122.75	Professional		$52.08	$72.66	$122.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.66 / $27.47 / $48.76	Professional	26	$22.66	$27.47	$48.76
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $26.04 / $31.40 / $44.17	Professional	52	$26.04	$31.40	$44.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.02 / $38.00 / $61.86	Professional	TC	$30.02	$38.00	$61.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.01 / $68.69 / $83.64	Professional		$53.01	$68.69	$83.64
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.29 / $27.94 / $34.78	Professional	26	$21.29	$27.94	$34.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.54 / $40.13 / $48.86	Professional	TC	$31.54	$40.13	$48.86
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $64.06 / $64.06 / $70.47	Professional		$64.06	$64.06	$70.47
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $26.60 / $26.60 / $29.26	Professional	26	$26.60	$26.60	$29.26
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $37.47 / $37.47 / $41.23	Professional	TC	$37.47	$37.47	$41.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $70.84 / $70.84 / $70.84	Facility		$70.84	$70.84	$70.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.14 / $30.14 / $30.14	Facility	26	$30.14	$30.14	$30.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.35 / $71.73 / $143.34	Professional		$51.35	$71.73	$143.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.94 / $29.72 / $61.97	Professional	26	$20.94	$29.72	$61.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.37 / $41.83 / $83.60	Professional	TC	$28.37	$41.83	$83.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.27 / $65.72 / $84.80	Professional		$54.27	$65.72	$84.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.82 / $26.29 / $33.92	Professional	26	$22.82	$26.29	$33.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.45 / $39.43 / $50.88	Professional	TC	$31.45	$39.43	$50.88
Medcost Facility/Professional Facility Modifier Low / Median / High Price $54.84 / $76.70 / $115.08	Facility		$54.84	$76.70	$115.08
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $26.00 / $27.26 / $49.56	Facility	26	$26.00	$27.26	$49.56
Medcost Facility/Professional Professional Modifier Low / Median / High Price $35.00 / $56.00 / $109.31	Professional		$35.00	$56.00	$109.31
Sentara Facility/Professional Facility Modifier Low / Median / High Price $27.08 / $54.18 / $94.16	Facility		$27.08	$54.18	$94.16
Sentara Facility/Professional Professional Modifier Low / Median / High Price $29.33 / $64.53 / $106.91	Professional		$29.33	$64.53	$106.91
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $24.17 / $30.62 / $50.82	Professional	26	$24.17	$30.62	$50.82
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $35.70 / $52.19 / $76.55	Professional	TC	$35.70	$52.19	$76.55
United Facility/Professional Professional Modifier Low / Median / High Price $41.44 / $57.38 / $92.77	Professional		$41.44	$57.38	$92.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.94 / $22.43 / $38.61	Professional	26	$17.94	$22.43	$38.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.22 / $34.60 / $54.68	Professional	TC	$23.22	$34.60	$54.68