Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $570.00 / $646.00 / $1,881.22	Facility		$570.00	$646.00	$1,881.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $570.00 / $623.20 / $646.00	Professional		$570.00	$623.20	$646.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,886.48 / $3,701.20 / $4,674.00	Facility		$2,886.48	$3,701.20	$4,674.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $846.27 / $846.27 / $1,289.20	Professional		$846.27	$846.27	$1,289.20
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $608.00 / $608.00 / $1,185.59	Professional		$608.00	$608.00	$1,185.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $494.00 / $1,675.25 / $3,893.34	Facility		$494.00	$1,675.25	$3,893.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $925.90 / $925.90 / $1,109.33	Professional		$925.90	$925.90	$1,109.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $760.00 / $912.00 / $1,124.80	Professional		$760.00	$912.00	$1,124.80
Medcost Facility/Professional Facility Modifier Low / Median / High Price $570.00 / $760.00 / $1,292.00	Facility		$570.00	$760.00	$1,292.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $897.00 / $1,330.00 / $1,824.00	Professional		$897.00	$1,330.00	$1,824.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $567.72 / $874.00 / $1,411.02	Facility		$567.72	$874.00	$1,411.02
Sentara Facility/Professional Professional Modifier Low / Median / High Price $567.72 / $874.00 / $1,411.02	Professional		$567.72	$874.00	$1,411.02
United Facility/Professional Professional Modifier Low / Median / High Price $319.20 / $395.20 / $819.28	Professional		$319.20	$395.20	$819.28