Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $257.50 / $1,938.00 / $8,294.00	Facility		$257.50	$1,938.00	$8,294.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $152.57 / $193.13 / $461.68	Facility	54	$152.57	$193.13	$461.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $203.43 / $294.70 / $533.39	Professional		$203.43	$294.70	$533.39
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $481.37 / $2,667.53 / $2,704.50	Professional	50	$481.37	$2,667.53	$2,704.50
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $152.57 / $193.13 / $290.52	Professional	54	$152.57	$193.13	$290.52
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $30.51 / $38.63 / $58.10	Professional	55	$30.51	$38.63	$58.10
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,735.00 / $2,390.00 / $2,954.00	Facility		$1,735.00	$2,390.00	$2,954.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $216.05 / $276.27 / $404.08	Professional		$216.05	$276.27	$404.08
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $324.07 / $414.42 / $599.82	Professional	50	$324.07	$414.42	$599.82
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $251.10 / $489.64 / $2,413.00	Professional		$251.10	$489.64	$2,413.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $387.32 / $387.32 / $387.32	Facility		$387.32	$387.32	$387.32
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $271.12 / $271.12 / $271.12	Facility	54	$271.12	$271.12	$271.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $234.96 / $354.97 / $546.04	Professional		$234.96	$354.97	$546.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $277.45 / $326.41 / $415.08	Professional		$277.45	$326.41	$415.08
Medcost Facility/Professional Facility Modifier Low / Median / High Price $232.74 / $375.25 / $652.59	Facility		$232.74	$375.25	$652.59
Medcost Facility/Professional Facility Modifier 50 Low / Median / High Price $499.55 / $792.65 / $1,248.82	Facility	50	$499.55	$792.65	$1,248.82
Medcost Facility/Professional Professional Modifier Low / Median / High Price $365.00 / $436.07 / $626.00	Professional		$365.00	$436.07	$626.00
Sentara Facility/Professional Facility Modifier Low / Median / High Price $230.42 / $342.24 / $2,755.00	Facility		$230.42	$342.24	$2,755.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $287.83 / $402.27 / $2,755.00	Professional		$287.83	$402.27	$2,755.00
United Facility/Professional Facility Modifier Low / Median / High Price $1,066.00 / $1,890.00 / $3,765.00	Facility		$1,066.00	$1,890.00	$3,765.00
United Facility/Professional Professional Modifier Low / Median / High Price $227.92 / $334.28 / $554.49	Professional		$227.92	$334.28	$554.49