Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.35 / $51.48 / $118.36	Facility	26	$42.35	$51.48	$118.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.27 / $98.85 / $127.12	Professional		$78.27	$98.85	$127.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.84 / $53.23 / $68.05	Professional	TC	$42.84	$53.23	$68.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.48 / $106.26 / $167.43	Professional		$79.48	$106.26	$167.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.08 / $55.75 / $87.84	Professional	TC	$38.08	$55.75	$87.84
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $101.07 / $101.07 / $197.09	Professional		$101.07	$101.07	$197.09
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $59.03 / $59.03 / $115.11	Professional	TC	$59.03	$59.03	$115.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.33 / $127.17 / $220.83	Professional		$78.33	$127.17	$220.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.06 / $65.65 / $115.82	Professional	TC	$23.06	$65.65	$115.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.57 / $101.74 / $127.82	Professional		$83.57	$101.74	$127.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.32 / $49.81 / $61.67	Professional	26	$40.32	$49.81	$61.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $43.25 / $50.88 / $66.14	Professional	TC	$43.25	$50.88	$66.14
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $43.53 / $64.00 / $123.50	Facility	26	$43.53	$64.00	$123.50
Medcost Facility/Professional Professional Modifier Low / Median / High Price $61.00 / $80.00 / $146.00	Professional		$61.00	$80.00	$146.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $49.29 / $107.59 / $207.68	Professional		$49.29	$107.59	$207.68
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $78.00 / $117.03	Professional	TC	$47.86	$78.00	$117.03
United Facility/Professional Professional Modifier Low / Median / High Price $71.91 / $119.84 / $197.19	Professional		$71.91	$119.84	$197.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.51 / $59.66 / $99.71	Professional	TC	$21.51	$59.66	$99.71