Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.68 / $398.26 / $2,819.92	Facility		$109.68	$398.26	$2,819.92
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $54.85 / $107.44 / $198.94	Facility	53	$54.85	$107.44	$198.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.30 / $309.13 / $927.53	Professional		$165.30	$309.13	$927.53
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $37.04 / $89.17 / $197.65	Professional	53	$37.04	$89.17	$197.65
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $1,369.00 / $1,369.00 / $1,369.00	Professional		$1,369.00	$1,369.00	$1,369.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $437.79 / $516.15 / $867.13	Facility		$437.79	$516.15	$867.13
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 $94.49 / $94.49 / $174.41	Professional	53	$94.49	$94.49	$174.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $284.02 / $420.40 / $602.50	Professional		$284.02	$420.40	$602.50
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $282.27 / $413.61 / $602.50	Professional	53	$282.27	$413.61	$602.50
United Facility/Professional Facility Modifier Low / Median / High Price $214.00 / $340.00 / $1,008.00	Facility		$214.00	$340.00	$1,008.00
United Facility/Professional Professional Modifier Low / Median / High Price $296.42 / $403.44 / $639.80	Professional		$296.42	$403.44	$639.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $402.88 / $448.05 / $497.84	Professional		$402.88	$448.05	$497.84
Wellpoint Facility/Professional Professional Modifier 53 Low / Median / High Price $201.19 / $223.82 / $248.69	Professional	53	$201.19	$223.82	$248.69