Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $312.81 / $343.68 / $1,683.00	Professional		$312.81	$343.68	$1,683.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.87 / $110.37 / $525.53	Professional	26	$105.87	$110.37	$525.53
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $186.01 / $297.13 / $326.69	Professional	52	$186.01	$297.13	$326.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $206.93 / $229.44 / $302.16	Professional	TC	$206.93	$229.44	$302.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $322.18 / $454.54 / $454.54	Professional		$322.18	$454.54	$454.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.96 / $125.18 / $190.15	Professional	26	$102.96	$125.18	$190.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $219.22 / $329.38 / $448.28	Professional	TC	$219.22	$329.38	$448.28
HMSA Facility/Professional Professional Modifier Low / Median / High Price $156.82 / $552.71 / $2,077.00	Professional		$156.82	$552.71	$2,077.00
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $160.13 / $172.14 / $180.25	Professional	26	$160.13	$172.14	$180.25
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $480.38 / $516.41 / $540.74	Professional	TC	$480.38	$516.41	$540.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $399.99 / $436.36 / $509.08	Professional		$399.99	$436.36	$509.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $110.15 / $120.17 / $140.19	Professional	26	$110.15	$120.17	$140.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $289.85 / $316.20 / $368.90	Professional	TC	$289.85	$316.20	$368.90
United Facility/Professional Professional Modifier Low / Median / High Price $370.90 / $454.54 / $598.13	Professional		$370.90	$454.54	$598.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $102.14 / $127.52 / $166.40	Professional	26	$102.14	$127.52	$166.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $268.77 / $329.38 / $431.73	Professional	TC	$268.77	$329.38	$431.73
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $68.03 / $484.68 / $629.38	Professional		$68.03	$484.68	$629.38
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $90.67 / $136.54	Professional	26	$17.07	$90.67	$136.54
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $50.96 / $270.72 / $407.67	Professional	TC	$50.96	$270.72	$407.67