Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.73 / $128.90 / $151.65	Facility	26	$113.73	$128.90	$151.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $328.98 / $380.51	Professional		$171.00	$328.98	$380.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $111.13 / $173.54	Professional	26	$51.30	$111.13	$173.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $206.95 / $217.84	Professional	TC	$119.70	$206.95	$217.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.66 / $129.66 / $129.66	Facility	26	$129.66	$129.66	$129.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.45 / $443.10 / $603.50	Professional		$316.45	$443.10	$603.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.05 / $132.07 / $165.26	Professional	26	$112.05	$132.07	$165.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $164.82 / $318.77 / $451.68	Professional	TC	$164.82	$318.77	$451.68
HMSA Facility/Professional Professional Modifier Low / Median / High Price $134.08 / $481.88 / $510.02	Professional		$134.08	$481.88	$510.02
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $146.97 / $153.90 / $157.74	Professional	26	$146.97	$153.90	$157.74
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $336.43 / $352.28 / $352.28	Professional	TC	$336.43	$352.28	$352.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $257.85 / $281.29 / $328.17	Professional		$257.85	$281.29	$328.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $123.56 / $134.80 / $157.26	Professional	26	$123.56	$134.80	$157.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.30 / $146.51 / $155.05	Professional	TC	$134.30	$146.51	$155.05
United Facility/Professional Professional Modifier Low / Median / High Price $271.99 / $555.76 / $810.89	Professional		$271.99	$555.76	$810.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.34 / $180.78 / $189.66	Professional	26	$72.34	$180.78	$189.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $164.82 / $375.48 / $621.23	Professional	TC	$164.82	$375.48	$621.23
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $294.13 / $399.31 / $602.23	Professional		$294.13	$399.31	$602.23
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $125.66 / $164.72 / $289.52	Professional	26	$125.66	$164.72	$289.52
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $151.53 / $271.89 / $395.69	Professional	TC	$151.53	$271.89	$395.69