Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,486.00 / $3,883.00 / $3,883.00	Facility		$1,486.00	$3,883.00	$3,883.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.09 / $279.37 / $1,088.40	Professional		$180.09	$279.37	$1,088.40
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $37.04 / $71.84 / $167.09	Professional	53	$37.04	$71.84	$167.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,088.40 / $1,088.40 / $1,088.40	Facility		$1,088.40	$1,088.40	$1,088.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $220.26 / $301.45 / $430.13	Professional		$220.26	$301.45	$430.13
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.90 / $88.55 / $264.32	Professional	53	$41.90	$88.55	$264.32
HMSA Facility/Professional Professional Modifier Low / Median / High Price $341.40 / $392.41 / $502.74	Professional		$341.40	$392.41	$502.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $197.76 / $359.65 / $493.64	Professional		$197.76	$359.65	$493.64
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $98.88 / $179.83 / $246.82	Professional	53	$98.88	$179.83	$246.82
United Facility/Professional Facility Modifier Low / Median / High Price $1,106.00 / $1,106.00 / $1,106.00	Facility		$1,106.00	$1,106.00	$1,106.00
United Facility/Professional Professional Modifier Low / Median / High Price $220.26 / $398.58 / $607.74	Professional		$220.26	$398.58	$607.74
United Facility/Professional Professional Modifier 53 Low / Median / High Price $173.92 / $204.61 / $204.61	Professional	53	$173.92	$204.61	$204.61
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $449.59 / $4,147.00 / $5,401.00	Professional		$449.59	$4,147.00	$5,401.00
University Health Alliance Facility/Professional Professional Modifier 53 Low / Median / High Price $166.23 / $1,761.00 / $4,081.00	Professional	53	$166.23	$1,761.00	$4,081.00