Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $158.49 / $257.04	Facility		$134.90	$158.49	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $234.42	Professional		$93.33	$125.89	$234.42
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $102.33 / $134.90 / $218.78	Professional	25	$102.33	$134.90	$218.78
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $123.03 / $123.03	Professional	52	$123.03	$123.03	$123.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $158.49 / $257.04	Professional		$117.49	$158.49	$257.04
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $120.23 / $165.96	Professional		$109.65	$120.23	$165.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Facility		$204.17	$204.17	$204.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Professional		$117.49	$117.49	$117.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $154.88 / $213.80	Professional		$123.03	$154.88	$213.80
Medcost Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $173.78 / $177.83	Professional		$151.36	$173.78	$177.83
Medcost Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $144.54 / $218.78	Facility		$104.71	$144.54	$218.78
Medcost Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $93.33 / $117.49	Professional		$77.62	$93.33	$117.49
Sentara Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $131.83 / $218.78	Facility		$104.71	$131.83	$218.78
Sentara Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $131.83 / $218.78	Professional		$104.71	$131.83	$218.78
United Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $138.04 / $154.88	Facility		$138.04	$138.04	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $131.83 / $208.93	Professional		$93.33	$131.83	$208.93