Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.35 / $160.81 / $384.78	Facility	26	$90.35	$160.81	$384.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $697.27 / $859.17 / $1,219.40	Professional		$697.27	$859.17	$1,219.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $604.90 / $771.35 / $1,085.81	Professional	TC	$604.90	$771.35	$1,085.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $852.33 / $1,089.64 / $1,528.07	Professional		$852.33	$1,089.64	$1,528.07
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $762.43 / $973.02 / $1,366.90	Professional	TC	$762.43	$973.02	$1,366.90
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $671.88 / $930.16 / $1,028.13	Professional		$671.88	$930.16	$1,028.13
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $175.72 / $814.31 / $814.31	Professional	TC	$175.72	$814.31	$814.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.28 / $114.28 / $114.28	Facility	26	$114.28	$114.28	$114.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $318.83 / $907.74 / $2,268.73	Professional		$318.83	$907.74	$2,268.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $209.74 / $834.61 / $1,991.66	Professional	TC	$209.74	$834.61	$1,991.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $925.99 / $1,283.97 / $1,325.72	Professional		$925.99	$1,283.97	$1,325.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $97.24 / $126.87 / $133.26	Professional	26	$97.24	$126.87	$133.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $828.75 / $1,157.10 / $1,187.36	Professional	TC	$828.75	$1,157.10	$1,187.36
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $138.00 / $148.69 / $299.10	Facility	26	$138.00	$148.69	$299.10
Medcost Facility/Professional Professional Modifier Low / Median / High Price $138.00 / $937.09 / $1,644.00	Professional		$138.00	$937.09	$1,644.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $128.63 / $865.78 / $2,014.24	Professional		$128.63	$865.78	$2,014.24
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $666.15 / $1,155.77 / $1,875.67	Professional	TC	$666.15	$1,155.77	$1,875.67
United Facility/Professional Professional Modifier Low / Median / High Price $365.38 / $866.15 / $1,533.21	Professional		$365.38	$866.15	$1,533.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $220.57 / $814.61 / $1,458.46	Professional	TC	$220.57	$814.61	$1,458.46