Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.61 / $46.03 / $54.15	Facility	26	$40.61	$46.03	$54.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $188.87 / $226.80 / $561.87	Professional		$188.87	$226.80	$561.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.65 / $54.70 / $136.61	Professional	26	$39.65	$54.70	$136.61
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $85.50 / $85.50 / $85.50	Professional	52	$85.50	$85.50	$85.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.13 / $177.61 / $221.14	Professional	TC	$169.13	$177.61	$221.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.27 / $46.27 / $46.27	Facility	26	$46.27	$46.27	$46.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $160.54 / $246.24 / $318.08	Professional		$160.54	$246.24	$318.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.03 / $63.12 / $70.58	Professional	26	$46.03	$63.12	$70.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.51 / $188.68 / $249.46	Professional	TC	$114.51	$188.68	$249.46
HMSA Facility/Professional Professional Modifier Low / Median / High Price $64.81 / $310.89 / $343.55	Professional		$64.81	$310.89	$343.55
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $71.04 / $74.39 / $76.25	Professional	26	$71.04	$74.39	$76.25
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $239.86 / $251.16 / $251.16	Professional	TC	$239.86	$251.16	$251.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $153.88 / $167.88 / $195.86	Professional		$153.88	$167.88	$195.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.12 / $48.13 / $56.15	Professional	26	$44.12	$48.13	$56.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $109.77 / $119.75 / $126.73	Professional	TC	$109.77	$119.75	$126.73
United Facility/Professional Professional Modifier Low / Median / High Price $79.67 / $188.87 / $338.54	Professional		$79.67	$188.87	$338.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.97 / $54.15 / $67.84	Professional	26	$25.97	$54.15	$67.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $142.08 / $166.95	Professional	TC	$53.70	$142.08	$166.95
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $173.34 / $301.08 / $500.94	Professional		$173.34	$301.08	$500.94
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $49.60 / $72.81 / $110.10	Professional	26	$49.60	$72.81	$110.10
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $123.74 / $224.04 / $394.70	Professional	TC	$123.74	$224.04	$394.70