Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,091.00 / $13,209.00 / $31,331.00	Facility		$3,091.00	$13,209.00	$31,331.00
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $19,034.40 / $19,034.40 / $19,034.40	Facility	22	$19,034.40	$19,034.40	$19,034.40
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $25,690.00 / $25,690.00 / $53,514.93	Facility	50	$25,690.00	$25,690.00	$53,514.93
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $996.74 / $1,145.24 / $2,726.37	Facility	54	$996.74	$1,145.24	$2,726.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,243.35 / $1,526.99 / $2,761.09	Professional		$1,243.35	$1,526.99	$2,761.09
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $168.79 / $328.69 / $339.03	Professional	AS	$168.79	$328.69	$339.03
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $21,861.00 / $27,843.00 / $30,195.00	Facility		$21,861.00	$27,843.00	$30,195.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,187.20 / $1,518.16 / $2,509.96	Professional		$1,187.20	$1,518.16	$2,509.96
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $166.20 / $212.54 / $351.39	Professional	AS	$166.20	$212.54	$351.39
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $1,417.77 / $1,559.55 / $11,336.00	Professional		$1,417.77	$1,559.55	$11,336.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $640.00 / $640.00 / $1,455.37	Facility		$640.00	$640.00	$1,455.37
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,008.15 / $1,008.15 / $1,008.15	Facility	54	$1,008.15	$1,008.15	$1,008.15
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $900.13 / $900.13 / $900.13	Facility	62	$900.13	$900.13	$900.13
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $144.02 / $144.02 / $144.02	Facility	AS	$144.02	$144.02	$144.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,285.98 / $1,773.06 / $2,893.18	Professional		$1,285.98	$1,773.06	$2,893.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,220.96 / $1,562.83 / $1,836.04	Professional		$1,220.96	$1,562.83	$1,836.04
Medcost Facility/Professional Facility Modifier Low / Median / High Price $1,328.99 / $1,874.03 / $2,794.39	Facility		$1,328.99	$1,874.03	$2,794.39
Medcost Facility/Professional Facility Modifier 50 Low / Median / High Price $2,593.60 / $3,693.30 / $5,282.02	Facility	50	$2,593.60	$3,693.30	$5,282.02
Medcost Facility/Professional Facility Modifier 80 Low / Median / High Price $345.81 / $492.44 / $704.27	Facility	80	$345.81	$492.44	$704.27
Medcost Facility/Professional Facility Modifier AS Low / Median / High Price $242.07 / $344.71 / $492.99	Facility	AS	$242.07	$344.71	$492.99
Medcost Facility/Professional Professional Modifier Low / Median / High Price $1,693.00 / $1,909.01 / $2,797.00	Professional		$1,693.00	$1,909.01	$2,797.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $1,272.67 / $1,788.63 / $5,916.28	Facility		$1,272.67	$1,788.63	$5,916.28
Sentara Facility/Professional Professional Modifier Low / Median / High Price $1,272.67 / $1,788.63 / $5,916.28	Professional		$1,272.67	$1,788.63	$5,916.28
United Facility/Professional Facility Modifier Low / Median / High Price $10,459.00 / $26,911.00 / $43,534.00	Facility		$10,459.00	$26,911.00	$43,534.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,114.38 / $1,699.20 / $2,654.56	Professional		$1,114.38	$1,699.20	$2,654.56