Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $64.57 / $75.86	Facility	26	$57.54	$64.57	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $275.42 / $602.56	Professional		$177.83	$275.42	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $61.66 / $288.40	Professional	26	$51.29	$61.66	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $177.83 / $371.54	Professional	TC	$120.23	$177.83	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $309.03 / $478.63	Professional		$245.47	$309.03	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $72.44 / $128.82	Professional	26	$48.98	$72.44	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $354.81	Professional	TC	$169.82	$257.04	$354.81
HMSA Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $467.74 / $512.86	Professional		$95.50	$467.74	$512.86
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $77.62 / $81.28	Professional	26	$75.86	$77.62	$81.28
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $363.08 / $380.19	Professional	TC	$363.08	$363.08	$380.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $218.78 / $275.42	Professional		$190.55	$218.78	$275.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $69.18 / $85.11	Professional	26	$58.88	$69.18	$85.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $151.36 / $190.55	Professional	TC	$131.83	$151.36	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $338.84 / $457.09	Professional		$204.17	$338.84	$457.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $75.86 / $125.89	Professional	26	$66.07	$75.86	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $245.47 / $380.19	Professional	TC	$134.90	$245.47	$380.19
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $363.08 / $691.83	Professional		$239.88	$363.08	$691.83
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $87.10 / $128.82	Professional	26	$64.57	$87.10	$128.82
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $295.12 / $575.44	Professional	TC	$165.96	$295.12	$575.44