Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.23 / $95.46 / $112.31	Facility	26	$84.23	$95.46	$112.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $386.08 / $488.59 / $522.50	Professional		$386.08	$488.59	$522.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.66 / $140.94 / $154.00	Professional	26	$128.66	$140.94	$154.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $125.00 / $125.00	Professional	52	$125.00	$125.00	$125.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $267.81 / $348.53 / $368.50	Professional	TC	$267.81	$348.53	$368.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $364.01 / $579.62 / $766.51	Professional		$364.01	$579.62	$766.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.42 / $99.09 / $123.12	Professional	26	$91.42	$99.09	$123.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $265.89 / $497.67 / $591.77	Professional	TC	$265.89	$497.67	$591.77
HMSA Facility/Professional Professional Modifier Low / Median / High Price $101.77 / $793.82 / $977.21	Professional		$101.77	$793.82	$977.21
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $111.55 / $116.81 / $119.73	Professional	26	$111.55	$116.81	$119.73
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $682.27 / $714.42 / $714.42	Professional	TC	$682.27	$714.42	$714.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $325.14 / $354.70 / $413.81	Professional		$325.14	$354.70	$413.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.51 / $99.83 / $116.47	Professional	26	$91.51	$99.83	$116.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $233.63 / $254.87 / $269.74	Professional	TC	$233.63	$254.87	$269.74
United Facility/Professional Professional Modifier Low / Median / High Price $169.03 / $399.03 / $521.90	Professional		$169.03	$399.03	$521.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.61 / $112.31 / $140.96	Professional	26	$51.61	$112.31	$140.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.42 / $286.73 / $380.94	Professional	TC	$117.42	$286.73	$380.94
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $366.23 / $667.71 / $985.09	Professional		$366.23	$667.71	$985.09
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $84.36 / $126.93 / $215.23	Professional	26	$84.36	$126.93	$215.23
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $263.36 / $558.97 / $835.28	Professional	TC	$263.36	$558.97	$835.28