Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.72 / $62.01 / $72.95	Facility	26	$54.72	$62.01	$72.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $207.21 / $299.57 / $338.16	Professional		$207.21	$299.57	$338.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $55.59 / $110.52	Professional	26	$50.07	$55.59	$110.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $175.12 / $224.62 / $279.66	Professional	TC	$175.12	$224.62	$279.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $241.65 / $289.04 / $377.83	Professional		$241.65	$289.04	$377.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.91 / $64.34 / $79.98	Professional	26	$59.91	$64.34	$79.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $164.46 / $235.70 / $312.88	Professional	TC	$164.46	$235.70	$312.88
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 $199.66 / $217.81 / $254.11	Professional		$199.66	$217.81	$254.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.44 / $64.84 / $75.66	Professional	26	$59.44	$64.84	$75.66
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 $110.66 / $245.04 / $543.54	Professional		$110.66	$245.04	$543.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.89 / $72.95 / $91.55	Professional	26	$34.89	$72.95	$91.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.77 / $172.08 / $245.55	Professional	TC	$75.77	$172.08	$245.55
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $224.89 / $352.91 / $628.28	Professional		$224.89	$352.91	$628.28
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $55.06 / $83.33 / $140.51	Professional	26	$55.06	$83.33	$140.51
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $158.06 / $289.38 / $525.79	Professional	TC	$158.06	$289.38	$525.79