Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.09 / $62.44 / $73.45	Facility	26	$55.09	$62.44	$73.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $122.77 / $245.54 / $347.77	Professional		$122.77	$245.54	$347.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.15 / $62.68 / $146.69	Professional	26	$52.15	$62.68	$146.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $184.73 / $228.97 / $285.08	Professional	TC	$184.73	$228.97	$285.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $244.01 / $313.20 / $415.97	Professional		$244.01	$313.20	$415.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.44 / $69.09 / $83.24	Professional	26	$62.44	$69.09	$83.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $161.87 / $256.51 / $330.03	Professional	TC	$161.87	$256.51	$330.03
HMSA Facility/Professional Professional Modifier Low / Median / High Price $70.15 / $436.08 / $514.46	Professional		$70.15	$436.08	$514.46
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $76.90 / $80.52 / $82.53	Professional	26	$76.90	$80.52	$82.53
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 $200.07 / $218.26 / $254.63	Professional		$200.07	$218.26	$254.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.85 / $65.29 / $76.17	Professional	26	$59.85	$65.29	$76.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $140.22 / $152.96 / $161.88	Professional	TC	$140.22	$152.96	$161.88
United Facility/Professional Professional Modifier Low / Median / High Price $112.22 / $245.54 / $337.54	Professional		$112.22	$245.54	$337.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.65 / $73.45 / $98.73	Professional	26	$37.65	$73.45	$98.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.56 / $172.08 / $243.99	Professional	TC	$74.56	$172.08	$243.99
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $225.35 / $392.88 / $686.18	Professional		$225.35	$392.88	$686.18
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $58.73 / $89.11 / $149.97	Professional	26	$58.73	$89.11	$149.97
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $158.06 / $312.33 / $573.09	Professional	TC	$158.06	$312.33	$573.09