Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $332.29 / $2,133.30 / $6,515.00	Facility		$332.29	$2,133.30	$6,515.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $97.74 / $179.43 / $283.51	Facility	52	$97.74	$179.43	$283.51
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $71.77 / $164.37 / $286.12	Facility	53	$71.77	$164.37	$286.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.10 / $332.29 / $572.47	Professional		$180.10	$332.29	$572.47
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $39.09 / $97.74 / $213.58	Professional	53	$39.09	$97.74	$213.58
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 $182.06 / $317.97 / $486.50	Professional		$182.06	$317.97	$486.50
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $88.63 / $163.66 / $265.70	Professional	53	$88.63	$163.66	$265.70
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $1,490.00 / $2,012.00 / $3,198.00	Professional		$1,490.00	$2,012.00	$3,198.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $243.26 / $497.08 / $1,035.00	Facility		$243.26	$497.08	$1,035.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $194.61 / $194.61 / $194.61	Facility	52	$194.61	$194.61	$194.61
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $48.65 / $48.65 / $48.65	Facility	53	$48.65	$48.65	$48.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.45 / $301.45 / $301.45	Professional		$301.45	$301.45	$301.45
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.90 / $88.55 / $106.08	Professional	53	$41.90	$88.55	$106.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $319.61 / $401.43 / $624.17	Professional		$319.61	$401.43	$624.17
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $319.61 / $394.81 / $624.17	Professional	53	$319.61	$394.81	$624.17
Medcost Facility/Professional Facility Modifier Low / Median / High Price $174.87 / $330.83 / $570.57	Facility		$174.87	$330.83	$570.57
Medcost Facility/Professional Professional Modifier Low / Median / High Price $196.62 / $485.00 / $624.00	Professional		$196.62	$485.00	$624.00
Medcost Facility/Professional Professional Modifier 53 Low / Median / High Price $476.77 / $476.77 / $476.77	Professional	53	$476.77	$476.77	$476.77
Sentara Facility/Professional Facility Modifier Low / Median / High Price $163.29 / $253.58 / $425.85	Facility		$163.29	$253.58	$425.85
Sentara Facility/Professional Professional Modifier Low / Median / High Price $255.79 / $459.02 / $781.48	Professional		$255.79	$459.02	$781.48
Sentara Facility/Professional Professional Modifier 53 Low / Median / High Price $139.25 / $229.46 / $407.74	Professional	53	$139.25	$229.46	$407.74
United Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $1,560.00 / $3,499.00	Facility		$250.00	$1,560.00	$3,499.00
United Facility/Professional Professional Modifier Low / Median / High Price $276.25 / $433.88 / $650.89	Professional		$276.25	$433.88	$650.89