Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.13 / $72.68 / $85.51	Facility	26	$64.13	$72.68	$85.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.40 / $315.58 / $655.50	Professional		$64.40	$315.58	$655.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.65 / $89.32 / $154.00	Professional	26	$62.65	$89.32	$154.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,218.00 / $1,218.00 / $1,218.00	Professional	50	$1,218.00	$1,218.00	$1,218.00
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 $158.87 / $238.31 / $348.53	Professional	TC	$158.87	$238.31	$348.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $267.75 / $439.60 / $552.47	Professional		$267.75	$439.60	$552.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.71 / $74.84 / $94.85	Professional	26	$61.71	$74.84	$94.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $193.35 / $344.75 / $442.29	Professional	TC	$193.35	$344.75	$442.29
HMSA Facility/Professional Professional Modifier Low / Median / High Price $79.19 / $673.30 / $806.44	Professional		$79.19	$673.30	$806.44
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $86.80 / $90.89 / $93.16	Professional	26	$86.80	$90.89	$93.16
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $586.50 / $614.14 / $614.14	Professional	TC	$586.50	$614.14	$614.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $244.43 / $266.64 / $311.08	Professional		$244.43	$266.64	$311.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.67 / $76.01 / $88.68	Professional	26	$69.67	$76.01	$88.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $174.76 / $190.64 / $201.76	Professional	TC	$174.76	$190.64	$201.76
United Facility/Professional Professional Modifier Low / Median / High Price $125.95 / $299.98 / $387.90	Professional		$125.95	$299.98	$387.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.77 / $85.51 / $108.51	Professional	26	$39.77	$85.51	$108.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.18 / $214.47 / $384.62	Professional	TC	$86.18	$214.47	$384.62
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $275.33 / $561.86 / $837.57	Professional		$275.33	$561.86	$837.57
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $64.79 / $96.31 / $164.36	Professional	26	$64.79	$96.31	$164.36
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $197.00 / $453.63 / $714.53	Professional	TC	$197.00	$453.63	$714.53