Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $79.43 / $93.33	Facility	26	$70.79	$79.43	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $426.58 / $1,412.54	Professional		$208.93	$426.58	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $112.20 / $426.58	Professional	26	$69.18	$112.20	$426.58
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 $134.90 / $213.80 / $562.34	Professional	TC	$134.90	$213.80	$562.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $478.63 / $602.56	Professional		$251.19	$478.63	$602.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $93.33 / $158.49	Professional	26	$64.57	$93.33	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $316.23 / $501.19	Professional	TC	$173.78	$316.23	$501.19
HMSA Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $741.31 / $812.83	Professional		$537.03	$741.31	$812.83
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $102.33 / $107.15	Professional	26	$100.00	$102.33	$107.15
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $575.44 / $602.56	Professional	TC	$575.44	$575.44	$602.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $251.19 / $295.12	Professional		$213.80	$251.19	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $83.18 / $97.72	Professional	26	$70.79	$83.18	$97.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $165.96 / $194.98	Professional	TC	$144.54	$165.96	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $338.84 / $691.83	Professional		$229.09	$338.84	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $100.00 / $151.36	Professional	26	$81.28	$100.00	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $223.87 / $602.56	Professional	TC	$147.91	$223.87	$602.56
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $524.81 / $851.14	Professional		$269.15	$524.81	$851.14
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $112.20 / $162.18	Professional	26	$85.11	$112.20	$162.18
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $389.05 / $707.95	Professional	TC	$181.97	$389.05	$707.95