Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $25.17 / $45.50 / $246.96	Facility		$25.17	$45.50	$246.96
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $81.92 / $86.56 / $106.65	Facility	25	$81.92	$86.56	$106.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.37 / $41.68 / $75.20	Professional		$23.37	$41.68	$75.20
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $30.12 / $54.76 / $110.13	Professional	25	$30.12	$54.76	$110.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.57 / $51.80 / $84.21	Professional		$32.57	$51.80	$84.21
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $21.57 / $29.24 / $51.41	Professional		$21.57	$29.24	$51.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.99 / $128.00 / $256.98	Facility		$46.99	$128.00	$256.98
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $29.37 / $29.37 / $29.37	Facility	62	$29.37	$29.37	$29.37
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $4.70 / $4.70 / $4.70	Facility	AS	$4.70	$4.70	$4.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.00 / $48.83 / $85.56	Professional		$29.00	$48.83	$85.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $49.96 / $65.56 / $93.68	Professional		$49.96	$65.56	$93.68
Medcost Facility/Professional Facility Modifier Low / Median / High Price $26.71 / $45.68 / $75.43	Facility		$26.71	$45.68	$75.43
Medcost Facility/Professional Facility Modifier 50 Low / Median / High Price $60.00 / $63.05 / $153.00	Facility	50	$60.00	$63.05	$153.00
Medcost Facility/Professional Facility Modifier 80 Low / Median / High Price $8.00 / $8.41 / $20.39	Facility	80	$8.00	$8.41	$20.39
Medcost Facility/Professional Facility Modifier AS Low / Median / High Price $5.60 / $5.88 / $14.28	Facility	AS	$5.60	$5.88	$14.28
Medcost Facility/Professional Professional Modifier Low / Median / High Price $51.00 / $61.00 / $96.77	Professional		$51.00	$61.00	$96.77
Sentara Facility/Professional Facility Modifier Low / Median / High Price $26.10 / $36.11 / $60.65	Facility		$26.10	$36.11	$60.65
Sentara Facility/Professional Professional Modifier Low / Median / High Price $43.01 / $56.58 / $96.58	Professional		$43.01	$56.58	$96.58
United Facility/Professional Professional Modifier Low / Median / High Price $33.82 / $50.36 / $82.63	Professional		$33.82	$50.36	$82.63