Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.05 / $64.66 / $76.06	Facility	26	$57.05	$64.66	$76.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $350.87 / $424.51	Professional		$171.00	$350.87	$424.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $52.78 / $87.10	Professional	26	$51.30	$52.78	$87.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $298.10 / $365.88	Professional	TC	$119.70	$298.10	$365.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $286.35 / $364.14 / $470.46	Professional		$286.35	$364.14	$470.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.85 / $67.62 / $83.91	Professional	26	$62.85	$67.62	$83.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.92 / $296.52 / $401.94	Professional	TC	$208.92	$296.52	$401.94
HMSA Facility/Professional Professional Modifier Low / Median / High Price $68.93 / $452.40 / $539.76	Professional		$68.93	$452.40	$539.76
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $75.55 / $79.11 / $81.09	Professional	26	$75.55	$79.11	$81.09
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $376.85 / $394.61 / $394.61	Professional	TC	$376.85	$394.61	$394.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.92 / $256.27 / $298.98	Professional		$234.92	$256.27	$298.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.99 / $67.62 / $78.89	Professional	26	$61.99	$67.62	$78.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $172.92 / $188.64 / $199.64	Professional	TC	$172.92	$188.64	$199.64
United Facility/Professional Professional Modifier Low / Median / High Price $132.87 / $288.31 / $403.91	Professional		$132.87	$288.31	$403.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.91 / $87.90 / $460.07	Professional	26	$67.91	$87.90	$460.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.25 / $212.22 / $312.98	Professional	TC	$96.25	$212.22	$312.98
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $264.62 / $449.51 / $766.07	Professional		$264.62	$449.51	$766.07
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $57.72 / $87.08 / $146.41	Professional	26	$57.72	$87.08	$146.41
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $194.93 / $382.91 / $638.09	Professional	TC	$194.93	$382.91	$638.09