Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.70 / $78.98 / $92.93	Facility	26	$69.70	$78.98	$92.93
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $57.62 / $57.62 / $57.62	Facility	53	$57.62	$57.62	$57.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $303.67 / $475.00 / $1,461.75	Professional		$303.67	$475.00	$1,461.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.31 / $99.16 / $238.55	Professional	26	$70.31	$99.16	$238.55
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $97.02 / $97.02 / $125.00	Professional	52	$97.02	$97.02	$125.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $195.17 / $206.64 / $368.50	Professional	TC	$195.17	$206.64	$368.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $45.11 / $45.11 / $45.11	Facility	53	$45.11	$45.11	$45.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $260.58 / $507.51 / $588.07	Professional		$260.58	$507.51	$588.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.73 / $82.46 / $101.96	Professional	26	$75.73	$82.46	$101.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $179.99 / $401.15 / $512.32	Professional	TC	$179.99	$401.15	$512.32
HMSA Facility/Professional Professional Modifier Low / Median / High Price $84.46 / $661.92 / $815.45	Professional		$84.46	$661.92	$815.45
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $92.59 / $96.95 / $99.37	Professional	26	$92.59	$96.95	$99.37
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $569.33 / $596.16 / $596.16	Professional	TC	$569.33	$596.16	$596.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.75 / $256.08 / $298.77	Professional		$234.75	$256.08	$298.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.72 / $82.61 / $96.38	Professional	26	$75.72	$82.61	$96.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $159.03 / $173.48 / $183.60	Professional	TC	$159.03	$173.48	$183.60
United Facility/Professional Professional Modifier Low / Median / High Price $122.55 / $288.10 / $453.28	Professional		$122.55	$288.10	$453.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.04 / $92.93 / $117.45	Professional	26	$43.04	$92.93	$117.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.51 / $195.17 / $257.70	Professional	TC	$79.51	$195.17	$257.70
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $264.39 / $586.63 / $845.58	Professional		$264.39	$586.63	$845.58
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $69.62 / $105.56 / $179.42	Professional	26	$69.62	$105.56	$179.42
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $179.27 / $419.91 / $717.32	Professional	TC	$179.27	$419.91	$717.32