Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $169.82 / $302.00	Professional		$128.82	$169.82	$302.00
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $169.82 / $223.87	Professional		$169.82	$169.82	$223.87
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 $151.36 / $151.36 / $204.17	Professional		$151.36	$151.36	$204.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $323.59 / $489.78	Professional		$223.87	$323.59	$489.78
United Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $158.49 / $245.47	Facility		$107.15	$158.49	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $158.49 / $251.19	Professional		$141.25	$158.49	$251.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $269.15	Professional		$190.55	$190.55	$269.15