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 $96.77 / $149.60 / $272.73	Professional		$96.77	$149.60	$272.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.88 / $49.16 / $114.54	Professional	26	$44.88	$49.16	$114.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.31 / $177.61 / $221.14	Professional	TC	$141.31	$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 $188.66 / $262.33 / $332.04	Professional		$188.66	$262.33	$332.04
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 $126.05 / $209.34 / $263.55	Professional	TC	$126.05	$209.34	$263.55
HMSA Facility/Professional Professional Modifier Low / Median / High Price $67.63 / $372.48 / $429.76	Professional		$67.63	$372.48	$429.76
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $72.43 / $75.84 / $77.73	Professional	26	$72.43	$75.84	$77.73
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 $154.72 / $168.79 / $196.92	Professional		$154.72	$168.79	$196.92
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 $103.63 / $113.05 / $119.65	Professional	TC	$103.63	$113.05	$119.65
United Facility/Professional Professional Modifier Low / Median / High Price $88.69 / $189.89 / $381.35	Professional		$88.69	$189.89	$381.35
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 $58.47 / $127.18 / $189.11	Professional	TC	$58.47	$127.18	$189.11
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $174.26 / $335.38 / $502.28	Professional		$174.26	$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 $116.82 / $265.49 / $396.53	Professional	TC	$116.82	$265.49	$396.53