Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $252.32 / $306.55 / $1,268.00	Professional		$252.32	$306.55	$1,268.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.45 / $81.68 / $361.65	Professional	26	$54.45	$81.68	$361.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.77 / $183.56 / $388.49	Professional	TC	$169.77	$183.56	$388.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.58 / $62.58 / $62.58	Facility	26	$62.58	$62.58	$62.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.80 / $352.99 / $708.04	Professional		$257.80	$352.99	$708.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.28 / $66.38 / $145.58	Professional	26	$51.28	$66.38	$145.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $187.73 / $286.63 / $586.25	Professional	TC	$187.73	$286.63	$586.25
HMSA Facility/Professional Professional Modifier Low / Median / High Price $106.40 / $343.07 / $450.46	Professional		$106.40	$343.07	$450.46
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $113.95 / $119.32 / $122.30	Professional	26	$113.95	$119.32	$122.30
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $276.00 / $289.01 / $349.38	Professional	TC	$276.00	$289.01	$349.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $310.63 / $338.87 / $395.35	Professional		$310.63	$338.87	$395.35
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.41 / $63.72 / $74.34	Professional	26	$58.41	$63.72	$74.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $252.23 / $275.16 / $321.02	Professional	TC	$252.23	$275.16	$321.02
United Facility/Professional Professional Modifier Low / Median / High Price $254.15 / $352.99 / $473.00	Professional		$254.15	$352.99	$473.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.16 / $70.65 / $89.85	Professional	26	$54.16	$70.65	$89.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $206.37 / $286.63 / $383.15	Professional	TC	$206.37	$286.63	$383.15
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $262.64 / $338.40 / $747.04	Professional		$262.64	$338.40	$747.04
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $49.03 / $66.91 / $138.22	Professional	26	$49.03	$66.91	$138.22
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $199.81 / $258.67 / $608.80	Professional	TC	$199.81	$258.67	$608.80