Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $69.18 / $81.28	Facility	26	$61.66	$69.18	$81.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $245.47 / $371.54	Professional		$169.82	$245.47	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $64.57 / $85.11	Professional	26	$44.67	$64.57	$85.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $177.83 / $281.84	Professional	TC	$120.23	$177.83	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $354.81 / $549.54	Professional		$302.00	$354.81	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $61.66 / $131.83	Professional	26	$48.98	$61.66	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $269.15 / $489.78	Professional	TC	$234.42	$269.15	$489.78
HMSA Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $776.25 / $851.14	Professional		$602.56	$776.25	$851.14
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $79.43 / $81.28	Professional	26	$75.86	$79.43	$81.28
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $630.96 / $630.96	Professional	TC	$602.56	$630.96	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $295.12 / $371.54	Professional		$251.19	$295.12	$371.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $74.13 / $93.33	Professional	26	$63.10	$74.13	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $218.78 / $275.42	Professional	TC	$190.55	$218.78	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $398.11 / $812.83	Professional		$269.15	$398.11	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $77.62 / $100.00	Professional	26	$43.65	$77.62	$100.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $295.12 / $741.31	Professional	TC	$223.87	$295.12	$741.31
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $416.87 / $1,258.93	Professional		$309.03	$416.87	$1,258.93
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $91.20 / $151.36	Professional	26	$66.07	$91.20	$151.36
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $331.13 / $1,148.15	Professional	TC	$229.09	$331.13	$1,148.15