Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.99 / $58.92 / $69.31	Facility	26	$51.99	$58.92	$69.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $153.44 / $216.19 / $363.48	Professional		$153.44	$216.19	$363.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.14 / $49.21 / $79.41	Professional	26	$36.14	$49.21	$79.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.31 / $166.97 / $284.06	Professional	TC	$117.31	$166.97	$284.06
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.80 / $59.80 / $59.80	Facility	26	$59.80	$59.80	$59.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $250.83 / $259.42 / $328.46	Professional		$250.83	$259.42	$328.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.23 / $63.65 / $76.81	Professional	26	$57.23	$63.65	$76.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $192.33 / $195.77 / $251.42	Professional	TC	$192.33	$195.77	$251.42
HMSA Facility/Professional Professional Modifier Low / Median / High Price $62.36 / $313.87 / $351.69	Professional		$62.36	$313.87	$351.69
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $68.34 / $71.56 / $73.36	Professional	26	$68.34	$71.56	$73.36
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $245.52 / $257.08 / $257.08	Professional	TC	$245.52	$257.08	$257.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $240.87 / $262.76 / $306.56	Professional		$240.87	$262.76	$306.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.49 / $61.62 / $71.89	Professional	26	$56.49	$61.62	$71.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $184.37 / $201.13 / $212.86	Professional	TC	$184.37	$201.13	$212.86
United Facility/Professional Professional Modifier Low / Median / High Price $126.73 / $295.61 / $395.18	Professional		$126.73	$295.61	$395.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.19 / $69.31 / $88.28	Professional	26	$32.19	$69.31	$88.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $94.54 / $226.27 / $306.89	Professional	TC	$94.54	$226.27	$306.89
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $271.33 / $361.28 / $535.94	Professional		$271.33	$361.28	$535.94
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $47.12 / $75.93 / $89.26	Professional	26	$47.12	$75.93	$89.26
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $161.78 / $256.60 / $306.43	Professional	TC	$161.78	$256.60	$306.43