Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.03 / $53.30 / $62.71	Facility	26	$47.03	$53.30	$62.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $150.38 / $200.01 / $272.73	Professional		$150.38	$200.01	$272.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.14 / $51.30 / $80.03	Professional	26	$44.14	$51.30	$80.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $160.31 / $177.61 / $221.14	Professional	TC	$160.31	$177.61	$221.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.16 / $262.68 / $333.13	Professional		$189.16	$262.68	$333.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.30 / $64.34 / $70.59	Professional	26	$53.30	$64.34	$70.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $126.55 / $209.68 / $264.64	Professional	TC	$126.55	$209.68	$264.64
HMSA Facility/Professional Professional Modifier Low / Median / High Price $65.59 / $371.95 / $429.76	Professional		$65.59	$371.95	$429.76
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $71.90 / $75.29 / $77.17	Professional	26	$71.90	$75.29	$77.17
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $300.05 / $314.19 / $314.19	Professional	TC	$300.05	$314.19	$314.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $155.13 / $169.25 / $197.46	Professional		$155.13	$169.25	$197.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.10 / $55.74 / $65.03	Professional	26	$51.10	$55.74	$65.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.04 / $113.50 / $120.12	Professional	TC	$104.04	$113.50	$120.12
United Facility/Professional Professional Modifier Low / Median / High Price $89.09 / $190.40 / $265.29	Professional		$89.09	$190.40	$265.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.22 / $62.71 / $79.11	Professional	26	$30.22	$62.71	$79.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.87 / $127.68 / $190.15	Professional	TC	$58.87	$127.68	$190.15
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $174.73 / $335.38 / $502.28	Professional		$174.73	$335.38	$502.28
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $47.63 / $77.53 / $121.05	Professional	26	$47.63	$77.53	$121.05
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $117.28 / $266.52 / $396.53	Professional	TC	$117.28	$266.52	$396.53