Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.08 / $79.42 / $93.43	Facility	26	$70.08	$79.42	$93.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $59.18 / $304.44 / $1,234.34	Professional		$59.18	$304.44	$1,234.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.03 / $126.00 / $329.78	Professional	26	$71.03	$126.00	$329.78
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 $198.89 / $335.00 / $368.50	Professional	TC	$198.89	$335.00	$368.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.44 / $494.96 / $579.23	Professional		$251.44	$494.96	$579.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.73 / $82.46 / $102.63	Professional	26	$75.73	$82.46	$102.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $170.52 / $380.93 / $496.77	Professional	TC	$170.52	$380.93	$496.77
HMSA Facility/Professional Professional Modifier Low / Median / High Price $84.46 / $724.08 / $904.48	Professional		$84.46	$724.08	$904.48
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 $631.49 / $661.25 / $661.25	Professional	TC	$631.49	$661.25	$661.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $228.21 / $248.95 / $290.44	Professional		$228.21	$248.95	$290.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.13 / $83.05 / $96.89	Professional	26	$76.13	$83.05	$96.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $152.08 / $165.90 / $175.58	Professional	TC	$152.08	$165.90	$175.58
United Facility/Professional Professional Modifier Low / Median / High Price $119.48 / $280.07 / $365.52	Professional		$119.48	$280.07	$365.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.04 / $93.43 / $117.45	Professional	26	$43.04	$93.43	$117.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.44 / $186.64 / $248.07	Professional	TC	$76.44	$186.64	$248.07
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $257.01 / $531.66 / $867.77	Professional		$257.01	$531.66	$867.77
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $70.43 / $106.76 / $179.42	Professional	26	$70.43	$106.76	$179.42
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $171.43 / $402.82 / $745.98	Professional	TC	$171.43	$402.82	$745.98