Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $389.69 / $489.69 / $757.32	Professional		$389.69	$489.69	$757.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.49 / $65.69 / $88.53	Professional	26	$59.49	$65.69	$88.53
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $194.85 / $194.85 / $269.69	Professional	52	$194.85	$194.85	$269.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $324.00 / $430.20 / $668.76	Professional	TC	$324.00	$430.20	$668.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $461.44 / $582.13 / $670.03	Professional		$461.44	$582.13	$670.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.52 / $81.29 / $100.68	Professional	26	$58.52	$81.29	$100.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $402.92 / $510.42 / $569.76	Professional	TC	$402.92	$510.42	$569.76
HMSA Facility/Professional Professional Modifier Low / Median / High Price $96.40 / $705.84 / $746.12	Professional		$96.40	$705.84	$746.12
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $101.60 / $108.31 / $113.41	Professional	26	$101.60	$108.31	$113.41
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $604.24 / $632.71 / $632.71	Professional	TC	$604.24	$632.71	$632.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $497.63 / $542.87 / $633.35	Professional		$497.63	$542.87	$633.35
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.11 / $68.84 / $80.31	Professional	26	$63.11	$68.84	$80.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $434.52 / $474.02 / $553.03	Professional	TC	$434.52	$474.02	$553.03
United Facility/Professional Professional Modifier Low / Median / High Price $413.68 / $536.37 / $698.23	Professional		$413.68	$536.37	$698.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.52 / $62.58 / $97.46	Professional	26	$58.52	$62.58	$97.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $351.10 / $439.39 / $600.77	Professional	TC	$351.10	$439.39	$600.77
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $304.68 / $539.71 / $664.78	Professional		$304.68	$539.71	$664.78
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $43.76 / $72.97 / $86.44	Professional	26	$43.76	$72.97	$86.44
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $260.91 / $462.19 / $580.67	Professional	TC	$260.91	$462.19	$580.67