Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.95 / $92.25 / $148.63	Professional		$72.95	$92.25	$148.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.83 / $12.44 / $20.07	Professional	26	$9.83	$12.44	$20.07
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $46.49 / $292.64 / $372.75	Professional	52	$46.49	$292.64	$372.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.41 / $114.47 / $131.53	Professional	TC	$81.41	$114.47	$131.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.54 / $13.54 / $13.54	Facility	26	$13.54	$13.54	$13.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $73.95 / $111.13 / $225.02	Professional		$73.95	$111.13	$225.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.95 / $14.04 / $26.13	Professional	26	$10.95	$14.04	$26.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.00 / $97.09 / $198.89	Professional	TC	$63.00	$97.09	$198.89
HMSA Facility/Professional Professional Modifier Low / Median / High Price $15.13 / $141.90 / $172.84	Professional		$15.13	$141.90	$172.84
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $16.20 / $16.96 / $17.39	Professional	26	$16.20	$16.96	$17.39
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $125.70 / $131.62 / $131.62	Professional	TC	$125.70	$131.62	$131.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.79 / $106.68 / $124.46	Professional		$97.79	$106.68	$124.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.35 / $13.48 / $15.72	Professional	26	$12.35	$13.48	$15.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $85.44 / $93.20 / $108.74	Professional	TC	$85.44	$93.20	$108.74
United Facility/Professional Professional Modifier Low / Median / High Price $80.01 / $111.13 / $145.68	Professional		$80.01	$111.13	$145.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.45 / $14.04 / $19.62	Professional	26	$11.45	$14.04	$19.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.90 / $106.70 / $126.06	Professional	TC	$69.90	$106.70	$126.06
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $80.70 / $108.24 / $233.40	Professional		$80.70	$108.24	$233.40
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $10.57 / $14.13 / $29.83	Professional	26	$10.57	$14.13	$29.83
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $70.13 / $94.06 / $203.57	Professional	TC	$70.13	$94.06	$203.57