Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $139.44 / $139.44 / $139.44	Facility		$139.44	$139.44	$139.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.20 / $76.13 / $139.44	Professional		$73.20	$76.13	$139.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $139.44 / $139.44 / $139.44	Facility		$139.44	$139.44	$139.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $73.20 / $73.20 / $94.11	Professional		$73.20	$73.20	$94.11
HMSA Facility/Professional Professional Modifier Low / Median / High Price $91.12 / $91.12 / $91.12	Professional		$91.12	$91.12	$91.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $73.20 / $87.84 / $109.80	Professional		$73.20	$87.84	$109.80
United Facility/Professional Professional Modifier Low / Median / High Price $73.20 / $77.59 / $109.80	Professional		$73.20	$77.59	$109.80
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $72.70 / $88.56 / $96.77	Professional		$72.70	$88.56	$96.77