Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $861.60 / $6,518.00 / $12,593.00	Facility		$861.60	$6,518.00	$12,593.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $115.49 / $115.49 / $172.32	Facility	53	$115.49	$115.49	$172.32
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $433.08 / $433.08 / $646.20	Facility	54	$433.08	$433.08	$646.20
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $86.62 / $86.62 / $129.24	Facility	55	$86.62	$86.62	$129.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $577.44 / $677.44 / $1,090.59	Professional		$577.44	$677.44	$1,090.59
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $79.20 / $101.62 / $129.24	Professional	55	$79.20	$101.62	$129.24
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $6,153.00 / $7,363.00 / $9,410.00	Facility		$6,153.00	$7,363.00	$9,410.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $609.70 / $783.13 / $1,106.71	Professional		$609.70	$783.13	$1,106.71
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $703.85 / $1,372.51 / $8,031.00	Professional		$703.85	$1,372.51	$8,031.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $756.80 / $756.80 / $756.80	Facility		$756.80	$756.80	$756.80
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $151.22 / $151.22 / $151.22	Facility	53	$151.22	$151.22	$151.22
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $529.26 / $529.26 / $529.26	Facility	54	$529.26	$529.26	$529.26
Cigna Facility/Professional Facility Modifier 55 Low / Median / High Price $113.41 / $113.41 / $113.41	Facility	55	$113.41	$113.41	$113.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $621.49 / $810.31 / $1,309.72	Professional		$621.49	$810.31	$1,309.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $630.57 / $741.85 / $956.44	Professional		$630.57	$741.85	$956.44
Medcost Facility/Professional Facility Modifier Low / Median / High Price $577.44 / $861.60 / $1,206.24	Facility		$577.44	$861.60	$1,206.24
Medcost Facility/Professional Professional Modifier Low / Median / High Price $937.00 / $1,176.67 / $1,594.70	Professional		$937.00	$1,176.67	$1,594.70
Sentara Facility/Professional Facility Modifier Low / Median / High Price $665.76 / $854.62 / $9,929.00	Facility		$665.76	$854.62	$9,929.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $665.76 / $854.62 / $9,929.00	Professional		$665.76	$854.62	$9,929.00
United Facility/Professional Facility Modifier Low / Median / High Price $6,398.00 / $10,466.00 / $21,639.00	Facility		$6,398.00	$10,466.00	$21,639.00
United Facility/Professional Professional Modifier Low / Median / High Price $534.44 / $727.68 / $1,276.48	Professional		$534.44	$727.68	$1,276.48