Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $729.29 / $799.35 / $1,115.74	Professional		$729.29	$799.35	$1,115.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.67 / $142.31 / $532.63	Professional	26	$123.67	$142.31	$532.63
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $137.96 / $331.88 / $434.65	Professional	52	$137.96	$331.88	$434.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $514.61 / $654.21 / $1,006.84	Professional	TC	$514.61	$654.21	$1,006.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $728.99 / $914.25 / $1,125.30	Professional		$728.99	$914.25	$1,125.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $122.51 / $169.00 / $232.69	Professional	26	$122.51	$169.00	$232.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $606.48 / $743.24 / $892.60	Professional	TC	$606.48	$743.24	$892.60
HMSA Facility/Professional Professional Modifier Low / Median / High Price $239.34 / $1,134.09 / $1,222.97	Professional		$239.34	$1,134.09	$1,222.97
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $236.35 / $268.91 / $281.58	Professional	26	$236.35	$268.91	$281.58
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $899.03 / $941.39 / $941.39	Professional	TC	$899.03	$941.39	$941.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $786.17 / $857.64 / $1,000.58	Professional		$786.17	$857.64	$1,000.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $132.12 / $144.13 / $168.15	Professional	26	$132.12	$144.13	$168.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $654.04 / $713.51 / $832.43	Professional	TC	$654.04	$713.51	$832.43
United Facility/Professional Professional Modifier Low / Median / High Price $647.54 / $811.11 / $1,088.66	Professional		$647.54	$811.11	$1,088.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $122.51 / $150.13 / $199.85	Professional	26	$122.51	$150.13	$199.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $519.38 / $653.46 / $888.81	Professional	TC	$519.38	$653.46	$888.81
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $617.67 / $910.02 / $1,055.83	Professional		$617.67	$910.02	$1,055.83
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $90.56 / $150.07 / $179.87	Professional	26	$90.56	$150.07	$179.87
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $418.12 / $740.66 / $874.05	Professional	TC	$418.12	$740.66	$874.05