Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.63 / $67.58 / $79.50	Facility	26	$59.63	$67.58	$79.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $330.93 / $349.43 / $430.29	Professional		$330.93	$349.43	$430.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.97 / $67.68 / $93.87	Professional	26	$60.97	$67.68	$93.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.94 / $288.44 / $359.11	Professional	TC	$239.94	$288.44	$359.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $232.46 / $361.03 / $463.88	Professional		$232.46	$361.03	$463.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.58 / $78.53 / $88.34	Professional	26	$67.58	$78.53	$88.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $163.46 / $282.50 / $363.46	Professional	TC	$163.46	$282.50	$363.46
HMSA Facility/Professional Professional Modifier Low / Median / High Price $80.41 / $447.31 / $514.46	Professional		$80.41	$447.31	$514.46
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $88.13 / $92.28 / $94.60	Professional	26	$88.13	$92.28	$94.60
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 $220.54 / $240.59 / $280.69	Professional		$220.54	$240.59	$280.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.78 / $70.67 / $82.45	Professional	26	$64.78	$70.67	$82.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $155.75 / $169.91 / $179.82	Professional	TC	$155.75	$169.91	$179.82
United Facility/Professional Professional Modifier Low / Median / High Price $116.46 / $270.66 / $343.48	Professional		$116.46	$270.66	$343.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.31 / $88.20 / $100.37	Professional	26	$38.31	$88.20	$100.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.15 / $191.15 / $243.11	Professional	TC	$78.15	$191.15	$243.11
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $248.40 / $439.66 / $760.76	Professional		$248.40	$439.66	$760.76
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $66.95 / $93.82 / $153.41	Professional	26	$66.95	$93.82	$153.41
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $175.57 / $327.18 / $638.09	Professional	TC	$175.57	$327.18	$638.09