Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $94.49 / $116.26 / $149.01	Professional		$94.49	$116.26	$149.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.16 / $14.82 / $18.92	Professional	26	$13.16	$14.82	$18.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.45 / $102.11 / $126.99	Professional	TC	$79.45	$102.11	$126.99
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $90.25 / $132.94 / $175.20	Professional		$90.25	$132.94	$175.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.22 / $15.81 / $19.37	Professional	26	$13.22	$15.81	$19.37
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $73.36 / $118.25 / $155.83	Professional	TC	$73.36	$118.25	$155.83
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $137.47 / $157.41 / $157.41	Professional		$137.47	$157.41	$157.41
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $16.96 / $16.96 / $20.21	Professional	26	$16.96	$16.96	$20.21
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $119.10 / $140.44 / $140.44	Professional	TC	$119.10	$140.44	$140.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.85 / $16.85 / $16.85	Facility	26	$16.85	$16.85	$16.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.67 / $131.97 / $253.27	Professional		$91.67	$131.97	$253.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.06 / $16.79 / $34.14	Professional	26	$13.06	$16.79	$34.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.86 / $114.69 / $218.55	Professional	TC	$77.86	$114.69	$218.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $113.39 / $140.80 / $180.17	Professional		$113.39	$140.80	$180.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.69 / $14.59 / $18.82	Professional	26	$12.69	$14.59	$18.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.70 / $126.21 / $161.49	Professional	TC	$100.70	$126.21	$161.49
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $15.48 / $15.48 / $20.00	Facility	26	$15.48	$15.48	$20.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $19.00 / $123.85 / $212.00	Professional		$19.00	$123.85	$212.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $16.38 / $98.44 / $182.74	Professional		$16.38	$98.44	$182.74
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $14.11 / $17.29 / $28.70	Professional	26	$14.11	$17.29	$28.70
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $77.04 / $112.19 / $186.07	Professional	TC	$77.04	$112.19	$186.07
United Facility/Professional Professional Modifier Low / Median / High Price $67.59 / $90.13 / $153.91	Professional		$67.59	$90.13	$153.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.88 / $12.62 / $23.25	Professional	26	$9.88	$12.62	$23.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.73 / $77.78 / $138.10	Professional	TC	$57.73	$77.78	$138.10