Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $77.62 / $91.20	Facility	26	$69.18	$77.62	$91.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $478.63 / $1,479.11	Professional		$251.19	$478.63	$1,479.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $125.89 / $512.86	Professional	26	$72.44	$125.89	$512.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $549.54 / $549.54 / $549.54	Professional	52	$549.54	$549.54	$549.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $302.00 / $602.56	Professional	TC	$181.97	$302.00	$602.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $501.19 / $676.08	Professional		$331.13	$501.19	$676.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $81.28 / $154.88	Professional	26	$58.88	$81.28	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $436.52 / $588.84	Professional	TC	$239.88	$436.52	$588.84
HMSA Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $724.44 / $812.83	Professional		$501.19	$724.44	$812.83
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $93.33 / $97.72	Professional	26	$91.20	$93.33	$97.72
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $562.34 / $588.84	Professional	TC	$562.34	$562.34	$588.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $302.00 / $354.81	Professional		$257.04	$302.00	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $81.28 / $95.50	Professional	26	$70.79	$81.28	$95.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $218.78 / $257.04	Professional	TC	$186.21	$218.78	$257.04
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $524.81 / $724.44	Professional		$275.42	$524.81	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $91.20 / $151.36	Professional	26	$79.43	$91.20	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $371.54 / $645.65	Professional	TC	$194.98	$371.54	$645.65
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $588.84 / $870.96	Professional		$323.59	$588.84	$870.96
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $100.00 / $154.88	Professional	26	$75.86	$100.00	$154.88
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $501.19 / $741.31	Professional	TC	$239.88	$501.19	$741.31