Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.77 / $74.54 / $87.70	Facility	26	$65.77	$74.54	$87.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.10 / $366.58 / $451.73	Professional		$275.10	$366.58	$451.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.39 / $91.07 / $222.61	Professional	26	$60.39	$91.07	$222.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $306.18 / $345.83 / $381.20	Professional	TC	$306.18	$345.83	$381.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.64 / $75.64 / $75.64	Facility	26	$75.64	$75.64	$75.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $308.67 / $416.55 / $509.42	Professional		$308.67	$416.55	$509.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.88 / $77.70 / $96.55	Professional	26	$71.88	$77.70	$96.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.12 / $338.85 / $419.86	Professional	TC	$234.12	$338.85	$419.86
HMSA Facility/Professional Professional Modifier Low / Median / High Price $79.59 / $517.91 / $616.83	Professional		$79.59	$517.91	$616.83
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $87.26 / $91.37 / $93.65	Professional	26	$87.26	$91.37	$93.65
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $430.66 / $450.95 / $450.95	Professional	TC	$430.66	$450.95	$450.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $295.89 / $322.79 / $376.59	Professional		$295.89	$322.79	$376.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $71.45 / $77.95 / $90.94	Professional	26	$71.45	$77.95	$90.94
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $224.43 / $244.84 / $259.12	Professional	TC	$224.43	$244.84	$259.12
United Facility/Professional Professional Modifier Low / Median / High Price $158.93 / $363.14 / $472.98	Professional		$158.93	$363.14	$472.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.38 / $87.70 / $110.61	Professional	26	$42.38	$87.70	$110.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.55 / $275.44 / $436.40	Professional	TC	$116.55	$275.44	$436.40
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $333.32 / $516.65 / $803.12	Professional		$333.32	$516.65	$803.12
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $66.31 / $100.98 / $169.44	Professional	26	$66.31	$100.98	$169.44
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $253.00 / $440.13 / $674.84	Professional	TC	$253.00	$440.13	$674.84