Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $776.25 / $1,819.70	Professional		$588.84	$776.25	$1,819.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $147.91 / $724.44	Professional	26	$114.82	$147.91	$724.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $512.86 / $512.86 / $512.86	Professional	52	$512.86	$512.86	$512.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $588.84 / $794.33	Professional	TC	$467.74	$588.84	$794.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,023.29 / $1,122.02	Professional		$831.76	$1,023.29	$1,122.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $181.97 / $234.42	Professional	26	$144.54	$181.97	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $676.08 / $870.96 / $891.25	Professional	TC	$676.08	$870.96	$891.25
HMSA Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,174.90 / $1,230.27	Professional		$794.33	$1,174.90	$1,230.27
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $269.15 / $281.84	Professional	26	$234.42	$269.15	$281.84
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $891.25 / $933.25 / $933.25	Professional	TC	$891.25	$933.25	$933.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $954.99 / $1,174.90	Professional		$870.96	$954.99	$1,174.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $151.36 / $190.55	Professional	26	$141.25	$151.36	$190.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $794.33 / $1,000.00	Professional	TC	$724.44	$794.33	$1,000.00
United Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $794.33 / $1,148.15	Professional		$630.96	$794.33	$1,148.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $147.91 / $229.09	Professional	26	$117.49	$147.91	$229.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $660.69 / $933.25	Professional	TC	$512.86	$660.69	$933.25
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $912.01 / $1,148.15	Professional		$616.60	$912.01	$1,148.15
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $162.18 / $186.21	Professional	26	$109.65	$162.18	$186.21
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $758.58 / $870.96	Professional	TC	$512.86	$758.58	$870.96