Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.71 / $68.80 / $80.95	Facility	26	$60.71	$68.80	$80.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $232.78 / $266.29 / $285.52	Professional		$232.78	$266.29	$285.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $64.39 / $121.99	Professional	26	$55.15	$64.39	$121.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.55 / $177.61 / $221.14	Professional	TC	$173.55	$177.61	$221.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.44 / $69.44 / $69.44	Facility	26	$69.44	$69.44	$69.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $205.50 / $247.24 / $322.24	Professional		$205.50	$247.24	$322.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.98 / $71.16 / $88.37	Professional	26	$65.98	$71.16	$88.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $121.29 / $188.18 / $250.19	Professional	TC	$121.29	$188.18	$250.19
HMSA Facility/Professional Professional Modifier Low / Median / High Price $72.52 / $319.35 / $343.55	Professional		$72.52	$319.35	$343.55
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $79.48 / $83.24 / $85.32	Professional	26	$79.48	$83.24	$85.32
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $239.86 / $251.16 / $251.16	Professional	TC	$239.86	$251.16	$251.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $178.59 / $194.82 / $227.29	Professional		$178.59	$194.82	$227.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $65.95 / $71.95 / $83.94	Professional	26	$65.95	$71.95	$83.94
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.63 / $122.87 / $130.04	Professional	TC	$112.63	$122.87	$130.04
United Facility/Professional Professional Modifier Low / Median / High Price $94.61 / $219.17 / $284.27	Professional		$94.61	$219.17	$284.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.90 / $87.90 / $487.27	Professional	26	$71.90	$87.90	$487.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.89 / $138.22 / $235.36	Professional	TC	$55.89	$138.22	$235.36
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $201.10 / $292.02 / $514.61	Professional		$201.10	$292.02	$514.61
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $60.76 / $90.67 / $155.19	Professional	26	$60.76	$90.67	$155.19
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $126.96 / $223.32 / $394.70	Professional	TC	$126.96	$223.32	$394.70