Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.88 / $69.68 / $164.43	Facility	26	$37.88	$69.68	$164.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $187.72 / $205.83 / $233.73	Professional		$187.72	$205.83	$233.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $148.24 / $164.70 / $192.25	Professional	TC	$148.24	$164.70	$192.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.19 / $237.87 / $332.02	Professional		$185.19	$237.87	$332.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.31 / $188.33 / $264.10	Professional	TC	$147.31	$188.33	$264.10
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $257.64 / $634.30 / $958.98	Professional		$257.64	$634.30	$958.98
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $209.77 / $209.77 / $262.20	Professional	TC	$209.77	$209.77	$262.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $180.17 / $300.64 / $493.05	Professional		$180.17	$300.64	$493.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $143.09 / $238.30 / $407.84	Professional	TC	$143.09	$238.30	$407.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $200.90 / $278.27 / $288.22	Professional		$200.90	$278.27	$288.22
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.89 / $54.36 / $56.63	Professional	26	$41.89	$54.36	$56.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $159.01 / $223.90 / $227.56	Professional	TC	$159.01	$223.90	$227.56
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $49.89 / $67.67 / $76.00	Facility	26	$49.89	$67.67	$76.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $60.00 / $278.00 / $414.00	Professional		$60.00	$278.00	$414.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $55.30 / $265.75 / $968.92	Professional		$55.30	$265.75	$968.92
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $192.81 / $260.01 / $424.23	Professional	TC	$192.81	$260.01	$424.23
United Facility/Professional Professional Modifier Low / Median / High Price $182.86 / $297.14 / $475.39	Professional		$182.86	$297.14	$475.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $149.90 / $243.30 / $384.07	Professional	TC	$149.90	$243.30	$384.07