Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.94 / $37.33 / $43.92	Facility	26	$32.94	$37.33	$43.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.34 / $184.62 / $522.72	Professional		$113.34	$184.62	$522.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.08 / $50.35 / $133.44	Professional	26	$33.08	$50.35	$133.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $48.69 / $249.00 / $337.50	Professional	52	$48.69	$249.00	$337.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.34 / $102.56 / $345.00	Professional	TC	$74.34	$102.56	$345.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.29 / $145.63 / $300.89	Professional		$92.29	$145.63	$300.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.32 / $41.51 / $74.43	Professional	26	$26.32	$41.51	$74.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.28 / $107.48 / $226.47	Professional	TC	$61.28	$107.48	$226.47
HMSA Facility/Professional Professional Modifier Low / Median / High Price $40.72 / $125.68 / $180.39	Professional		$40.72	$125.68	$180.39
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $43.20 / $45.24 / $46.37	Professional	26	$43.20	$45.24	$46.37
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $126.72 / $132.69 / $142.52	Professional	TC	$126.72	$132.69	$142.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $139.61 / $152.30 / $177.69	Professional		$139.61	$152.30	$177.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.78 / $39.04 / $45.54	Professional	26	$35.78	$39.04	$45.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $103.83 / $113.27 / $132.15	Professional	TC	$103.83	$113.27	$132.15
United Facility/Professional Professional Modifier Low / Median / High Price $86.60 / $149.75 / $917.19	Professional		$86.60	$149.75	$917.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.94 / $43.92 / $54.72	Professional	26	$32.94	$43.92	$54.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.86 / $127.43 / $153.94	Professional	TC	$89.86	$127.43	$153.94
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $117.99 / $191.50 / $319.72	Professional		$117.99	$191.50	$319.72
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $32.79 / $50.64 / $83.90	Professional	26	$32.79	$50.64	$83.90
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $87.86 / $138.75 / $235.82	Professional	TC	$87.86	$138.75	$235.82