Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $376.99 / $620.19 / $1,126.86	Facility	26	$376.99	$620.19	$1,126.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,743.13 / $1,889.42 / $3,519.56	Professional		$1,743.13	$1,889.42	$3,519.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $347.38 / $400.42 / $766.69	Professional	26	$347.38	$400.42	$766.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,363.42 / $1,542.04 / $2,760.26	Professional	TC	$1,363.42	$1,542.04	$2,760.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,701.35 / $2,158.14 / $3,182.10	Professional		$1,701.35	$2,158.14	$3,182.10
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $383.85 / $490.86 / $736.96	Professional	26	$383.85	$490.86	$736.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,317.50 / $1,664.23 / $2,464.17	Professional	TC	$1,317.50	$1,664.23	$2,464.17
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $2,179.55 / $2,179.55 / $5,676.45	Professional		$2,179.55	$2,179.55	$5,676.45
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $427.87 / $427.87 / $439.44	Professional	26	$427.87	$427.87	$439.44
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $1,209.28 / $1,751.68 / $1,751.68	Professional	TC	$1,209.28	$1,751.68	$1,751.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $477.29 / $477.29 / $477.29	Facility	26	$477.29	$477.29	$477.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,503.65 / $2,447.33 / $4,747.70	Professional		$1,503.65	$2,447.33	$4,747.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $363.92 / $552.66 / $1,043.57	Professional	26	$363.92	$552.66	$1,043.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,158.34 / $1,892.07 / $3,689.98	Professional	TC	$1,158.34	$1,892.07	$3,689.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,824.58 / $2,508.01 / $2,617.41	Professional		$1,824.58	$2,508.01	$2,617.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $416.20 / $545.89 / $601.89	Professional	26	$416.20	$545.89	$601.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,408.38 / $1,966.67 / $2,015.52	Professional	TC	$1,408.38	$1,966.67	$2,015.52
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $487.89 / $674.00 / $1,241.54	Facility	26	$487.89	$674.00	$1,241.54
Medcost Facility/Professional Professional Modifier Low / Median / High Price $542.33 / $2,269.00 / $3,497.00	Professional		$542.33	$2,269.00	$3,497.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $522.62 / $2,247.56 / $7,650.00	Professional		$522.62	$2,247.56	$7,650.00
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $419.84 / $598.57 / $914.59	Professional	26	$419.84	$598.57	$914.59
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $1,378.67 / $2,148.23 / $3,489.48	Professional	TC	$1,378.67	$2,148.23	$3,489.48
United Facility/Professional Professional Modifier Low / Median / High Price $1,539.04 / $2,318.96 / $3,537.89	Professional		$1,539.04	$2,318.96	$3,537.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $261.64 / $516.64 / $752.99	Professional	26	$261.64	$516.64	$752.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,201.55 / $1,802.32 / $3,159.46	Professional	TC	$1,201.55	$1,802.32	$3,159.46