Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.97 / $57.77 / $67.95	Facility	26	$50.97	$57.77	$67.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.86 / $171.00 / $272.73	Professional		$100.86	$171.00	$272.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.92 / $51.60 / $110.52	Professional	26	$45.92	$51.60	$110.52
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 $159.05 / $201.03 / $401.61	Professional	TC	$159.05	$201.03	$401.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $193.49 / $262.68 / $332.44	Professional		$193.49	$262.68	$332.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.58 / $64.34 / $75.51	Professional	26	$55.58	$64.34	$75.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $121.29 / $209.68 / $262.45	Professional	TC	$121.29	$209.68	$262.45
HMSA Facility/Professional Professional Modifier Low / Median / High Price $65.59 / $371.95 / $429.76	Professional		$65.59	$371.95	$429.76
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $71.90 / $75.29 / $77.17	Professional	26	$71.90	$75.29	$77.17
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $300.05 / $314.19 / $314.19	Professional	TC	$300.05	$314.19	$314.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.60 / $173.02 / $201.85	Professional		$158.60	$173.02	$201.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.37 / $60.41 / $70.48	Professional	26	$55.37	$60.41	$70.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $103.22 / $112.61 / $119.18	Professional	TC	$103.22	$112.61	$119.18
United Facility/Professional Professional Modifier Low / Median / High Price $90.78 / $194.64 / $265.83	Professional		$90.78	$194.64	$265.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.89 / $67.95 / $91.55	Professional	26	$34.89	$67.95	$91.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.89 / $126.68 / $189.12	Professional	TC	$55.89	$126.68	$189.12
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $178.61 / $335.38 / $502.28	Professional		$178.61	$335.38	$502.28
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $51.88 / $82.28 / $131.74	Professional	26	$51.88	$82.28	$131.74
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $116.36 / $243.02 / $396.53	Professional	TC	$116.36	$243.02	$396.53