Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $119.73 / $410.31 / $661.30	Facility		$119.73	$410.31	$661.30
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.79 / $30.36 / $35.72	Facility	26	$26.79	$30.36	$35.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.25 / $168.23 / $596.00	Professional		$118.25	$168.23	$596.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.29 / $37.28 / $100.25	Professional	26	$5.29	$37.28	$100.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $46.51 / $84.11 / $84.11	Professional	52	$46.51	$84.11	$84.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.34 / $102.17 / $155.47	Professional	TC	$72.34	$102.17	$155.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $123.40 / $123.40 / $123.40	Facility		$123.40	$123.40	$123.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.47 / $30.47 / $30.47	Facility	26	$30.47	$30.47	$30.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.16 / $135.76 / $288.55	Professional		$85.16	$135.76	$288.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $33.58 / $60.24	Professional	26	$21.38	$33.58	$60.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.89 / $105.33 / $228.31	Professional	TC	$56.89	$105.33	$228.31
HMSA Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $158.00 / $178.17	Professional		$32.36	$158.00	$178.17
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $34.65 / $36.29 / $40.85	Professional	26	$34.65	$36.29	$40.85
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $123.34 / $129.15 / $140.97	Professional	TC	$123.34	$129.15	$140.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $130.08 / $141.90 / $165.55	Professional		$130.08	$141.90	$165.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.11 / $31.75 / $37.04	Professional	26	$29.11	$31.75	$37.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.97 / $110.15 / $128.51	Professional	TC	$100.97	$110.15	$128.51
United Facility/Professional Professional Modifier Low / Median / High Price $118.01 / $159.63 / $197.25	Professional		$118.01	$159.63	$197.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.79 / $35.72 / $44.55	Professional	26	$26.79	$35.72	$44.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.36 / $123.92 / $152.69	Professional	TC	$81.36	$123.92	$152.69
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $96.55 / $173.72 / $306.54	Professional		$96.55	$173.72	$306.54
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $24.49 / $40.19 / $67.87	Professional	26	$24.49	$40.19	$67.87
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $70.77 / $132.34 / $238.67	Professional	TC	$70.77	$132.34	$238.67