Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $40.74 / $47.86	Facility	26	$36.31	$40.74	$47.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $181.97 / $537.03	Professional		$109.65	$181.97	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $50.12 / $151.36	Professional	26	$32.36	$50.12	$151.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $36.31 / $144.54 / $831.76	Professional	52	$36.31	$144.54	$831.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $102.33 / $549.54	Professional	TC	$79.43	$102.33	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $173.78 / $295.12	Professional		$109.65	$173.78	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $45.71 / $77.62	Professional	26	$29.51	$45.71	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $128.82 / $213.80	Professional	TC	$81.28	$128.82	$213.80
HMSA Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $177.83 / $204.17	Professional		$144.54	$177.83	$204.17
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $47.86 / $50.12	Professional	26	$46.77	$47.86	$50.12
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $138.04 / $154.88	Professional	TC	$131.83	$138.04	$154.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $165.96 / $194.98	Professional		$154.88	$165.96	$194.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $42.66 / $50.12	Professional	26	$38.90	$42.66	$50.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $123.03 / $144.54	Professional	TC	$114.82	$123.03	$144.54
United Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $190.55 / $263.03	Professional		$147.91	$190.55	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $51.29 / $72.44	Professional	26	$41.69	$51.29	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $138.04 / $190.55	Professional	TC	$107.15	$138.04	$190.55
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $229.09 / $354.81	Professional		$173.78	$229.09	$354.81
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $57.54 / $89.13	Professional	26	$45.71	$57.54	$89.13
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $165.96 / $269.15	Professional	TC	$128.82	$165.96	$269.15