Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $385.76 / $2,442.00 / $6,827.70	Facility		$385.76	$2,442.00	$6,827.70
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $201.14 / $214.04 / $605.48	Facility	54	$201.14	$214.04	$605.48
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $40.22 / $42.81 / $121.10	Facility	55	$40.22	$42.81	$121.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $260.42 / $373.09 / $593.89	Professional		$260.42	$373.09	$593.89
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,425.00 / $2,167.50 / $2,308.50	Professional	50	$1,425.00	$2,167.50	$2,308.50
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $195.32 / $230.63 / $323.58	Professional	54	$195.32	$230.63	$323.58
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $39.06 / $46.13 / $64.72	Professional	55	$39.06	$46.13	$64.72
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 $279.30 / $358.74 / $506.97	Professional		$279.30	$358.74	$506.97
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $418.95 / $538.12 / $760.46	Professional	50	$418.95	$538.12	$760.46
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $333.33 / $649.99 / $2,764.00	Professional		$333.33	$649.99	$2,764.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $507.88 / $507.88 / $507.88	Facility		$507.88	$507.88	$507.88
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $355.52 / $355.52 / $355.52	Facility	54	$355.52	$355.52	$355.52
Cigna Facility/Professional Facility Modifier 55 Low / Median / High Price $76.18 / $76.18 / $76.18	Facility	55	$76.18	$76.18	$76.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $272.56 / $375.00 / $623.15	Professional		$272.56	$375.00	$623.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $311.27 / $366.20 / $466.10	Professional		$311.27	$366.20	$466.10
Medcost Facility/Professional Facility Modifier Low / Median / High Price $284.48 / $381.94 / $631.58	Facility		$284.48	$381.94	$631.58
Medcost Facility/Professional Facility Modifier 50 Low / Median / High Price $568.28 / $815.10 / $1,777.50	Facility	50	$568.28	$815.10	$1,777.50
Medcost Facility/Professional Professional Modifier Low / Median / High Price $396.00 / $449.00 / $629.96	Professional		$396.00	$449.00	$629.96
Sentara Facility/Professional Facility Modifier Low / Median / High Price $257.54 / $368.07 / $2,628.00	Facility		$257.54	$368.07	$2,628.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $262.80 / $396.26 / $2,628.00	Professional		$262.80	$396.26	$2,628.00
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 $228.63 / $306.94 / $582.88	Professional		$228.63	$306.94	$582.88