Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $136.97 / $315.35 / $425.85	Facility		$136.97	$315.35	$425.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.96 / $103.66 / $130.54	Professional		$58.96	$103.66	$130.54
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $119.16 / $119.16 / $119.16	Professional	25	$119.16	$119.16	$119.16
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $57.12 / $57.12 / $57.12	Professional	CQ	$57.12	$57.12	$57.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $228.61 / $228.61 / $228.61	Facility		$228.61	$228.61	$228.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.78 / $98.91 / $130.54	Professional		$61.78	$98.91	$130.54
HMSA Facility/Professional Professional Modifier Low / Median / High Price $82.08 / $108.33 / $117.40	Professional		$82.08	$108.33	$117.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.43 / $114.87 / $130.54	Professional		$104.43	$114.87	$130.54
United Facility/Professional Professional Modifier Low / Median / High Price $78.93 / $112.34 / $140.18	Professional		$78.93	$112.34	$140.18
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $92.53 / $124.63 / $257.50	Professional		$92.53	$124.63	$257.50