Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.16 / $98.60 / $312.33	Facility	26	$82.16	$98.60	$312.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $193.50 / $228.69 / $345.80	Professional		$193.50	$228.69	$345.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $109.82 / $180.57	Professional	26	$50.00	$109.82	$180.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.64 / $148.03 / $655.00	Professional	TC	$120.64	$148.03	$655.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $225.21 / $249.76 / $298.01	Professional		$225.21	$249.76	$298.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.12 / $100.27 / $119.81	Professional	26	$90.12	$100.27	$119.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.84 / $149.50 / $187.21	Professional	TC	$129.84	$149.50	$187.21
HMSA Facility/Professional Professional Modifier Low / Median / High Price $129.18 / $728.93 / $841.23	Professional		$129.18	$728.93	$841.23
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $141.60 / $148.27 / $151.97	Professional	26	$141.60	$148.27	$151.97
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $587.33 / $615.00 / $616.84	Professional	TC	$587.33	$615.00	$616.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $217.22 / $236.96 / $276.45	Professional		$217.22	$236.96	$276.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $89.27 / $97.38 / $113.61	Professional	26	$89.27	$97.38	$113.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $127.95 / $139.58 / $147.72	Professional	TC	$127.95	$139.58	$147.72
United Facility/Professional Professional Modifier Low / Median / High Price $115.43 / $266.58 / $332.96	Professional		$115.43	$266.58	$332.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.58 / $122.69 / $137.54	Professional	26	$52.58	$122.69	$137.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.85 / $157.03 / $195.42	Professional	TC	$62.85	$157.03	$195.42
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $244.59 / $314.95 / $513.22	Professional		$244.59	$314.95	$513.22
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $91.17 / $125.79 / $210.04	Professional	26	$91.17	$125.79	$210.04
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $150.37 / $186.41 / $315.52	Professional	TC	$150.37	$186.41	$315.52