Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.01 / $68.01 / $80.01	Facility	26	$60.01	$68.01	$80.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.67 / $310.77 / $346.44	Professional		$281.67	$310.77	$346.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.86 / $83.13 / $91.62	Professional	26	$54.86	$83.13	$91.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $219.15 / $226.80 / $282.38	Professional	TC	$219.15	$226.80	$282.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $216.46 / $313.48 / $353.23	Professional		$216.46	$313.48	$353.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.25 / $70.73 / $87.36	Professional	26	$65.25	$70.73	$87.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.41 / $255.15 / $286.26	Professional	TC	$148.41	$255.15	$286.26
HMSA Facility/Professional Professional Modifier Low / Median / High Price $72.13 / $438.24 / $514.46	Professional		$72.13	$438.24	$514.46
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $79.06 / $82.79 / $84.86	Professional	26	$79.06	$82.79	$84.86
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $359.18 / $376.10 / $376.10	Professional	TC	$359.18	$376.10	$376.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $207.45 / $226.31 / $264.02	Professional		$207.45	$226.31	$264.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $65.20 / $71.12 / $82.98	Professional	26	$65.20	$71.12	$82.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $142.26 / $155.19 / $164.25	Professional	TC	$142.26	$155.19	$164.25
United Facility/Professional Professional Modifier Low / Median / High Price $109.50 / $254.60 / $321.80	Professional		$109.50	$254.60	$321.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.31 / $80.01 / $100.37	Professional	26	$38.31	$80.01	$100.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.19 / $174.60 / $221.43	Professional	TC	$71.19	$174.60	$221.43
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $233.65 / $333.03 / $718.67	Professional		$233.65	$333.03	$718.67
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $60.07 / $90.16 / $153.41	Professional	26	$60.07	$90.16	$153.41
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $160.37 / $245.39 / $591.34	Professional	TC	$160.37	$245.39	$591.34