Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $359.20 / $2,577.61 / $6,827.70	Facility		$359.20	$2,577.61	$6,827.70
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $97.94 / $179.61 / $284.05	Facility	52	$97.94	$179.61	$284.05
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $42.37 / $113.75 / $233.49	Facility	53	$42.37	$113.75	$233.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.32 / $318.99 / $532.44	Professional		$180.32	$318.99	$532.44
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $39.17 / $98.12 / $192.33	Professional	53	$39.17	$98.12	$192.33
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 $182.39 / $318.27 / $487.65	Professional		$182.39	$318.27	$487.65
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $88.95 / $164.00 / $266.23	Professional	53	$88.95	$164.00	$266.23
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 $243.68 / $497.08 / $1,035.00	Facility		$243.68	$497.08	$1,035.00
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $194.94 / $194.94 / $194.94	Facility	52	$194.94	$194.94	$194.94
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $48.74 / $48.74 / $48.74	Facility	53	$48.74	$48.74	$48.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.75 / $301.75 / $301.75	Professional		$301.75	$301.75	$301.75
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 $319.93 / $401.73 / $624.80	Professional		$319.93	$401.73	$624.80
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $319.93 / $395.21 / $624.80	Professional	53	$319.93	$395.21	$624.80
Medcost Facility/Professional Facility Modifier Low / Median / High Price $178.30 / $331.64 / $571.14	Facility		$178.30	$331.64	$571.14
Medcost Facility/Professional Professional Modifier Low / Median / High Price $197.01 / $486.00 / $625.00	Professional		$197.01	$486.00	$625.00
Medcost Facility/Professional Professional Modifier 53 Low / Median / High Price $478.20 / $478.20 / $478.20	Professional	53	$478.20	$478.20	$478.20
Sentara Facility/Professional Facility Modifier Low / Median / High Price $160.96 / $250.84 / $481.96	Facility		$160.96	$250.84	$481.96
Sentara Facility/Professional Professional Modifier Low / Median / High Price $296.63 / $441.50 / $782.99	Professional		$296.63	$441.50	$782.99
Sentara Facility/Professional Professional Modifier 53 Low / Median / High Price $133.93 / $236.23 / $571.53	Professional	53	$133.93	$236.23	$571.53
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 $285.27 / $465.05 / $700.84	Professional		$285.27	$465.05	$700.84