Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.03 / $69.48 / $185.00	Facility		$39.03	$69.48	$185.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $9.16 / $127.88 / $171.33	Facility	25	$9.16	$127.88	$171.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.10 / $69.79 / $124.74	Professional		$43.10	$69.79	$124.74
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $53.69 / $88.04 / $175.97	Professional	25	$53.69	$88.04	$175.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.51 / $86.11 / $135.60	Professional		$59.51	$86.11	$135.60
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $43.11 / $56.47 / $84.06	Professional		$43.11	$56.47	$84.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $128.00 / $256.98	Facility		$88.08	$128.00	$256.98
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.51 / $82.98 / $139.96	Professional		$52.51	$82.98	$139.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $84.00 / $105.29 / $160.44	Professional		$84.00	$105.29	$160.44
Medcost Facility/Professional Facility Modifier Low / Median / High Price $50.43 / $75.48 / $118.92	Facility		$50.43	$75.48	$118.92
Medcost Facility/Professional Facility Modifier 50 Low / Median / High Price $85.50 / $106.73 / $215.55	Facility	50	$85.50	$106.73	$215.55
Medcost Facility/Professional Facility Modifier 80 Low / Median / High Price $11.40 / $14.23 / $28.74	Facility	80	$11.40	$14.23	$28.74
Medcost Facility/Professional Facility Modifier AS Low / Median / High Price $7.98 / $9.96 / $20.12	Facility	AS	$7.98	$9.96	$20.12
Medcost Facility/Professional Professional Modifier Low / Median / High Price $81.00 / $101.00 / $154.13	Professional		$81.00	$101.00	$154.13
Sentara Facility/Professional Facility Modifier Low / Median / High Price $49.12 / $67.34 / $111.26	Facility		$49.12	$67.34	$111.26
Sentara Facility/Professional Professional Modifier Low / Median / High Price $67.95 / $91.90 / $156.06	Professional		$67.95	$91.90	$156.06
United Facility/Professional Professional Modifier Low / Median / High Price $49.09 / $77.20 / $132.44	Professional		$49.09	$77.20	$132.44