Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.97 / $57.77 / $67.95	Facility	26	$50.97	$57.77	$67.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.40 / $165.26 / $215.69	Professional		$134.40	$165.26	$215.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.10 / $53.10 / $77.81	Professional	26	$46.10	$53.10	$77.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.29 / $107.19 / $167.46	Professional	TC	$88.29	$107.19	$167.46
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.76 / $171.20 / $223.79	Professional		$161.76	$171.20	$223.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.28 / $61.39 / $73.91	Professional	26	$55.28	$61.39	$73.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $106.66 / $113.43 / $148.28	Professional	TC	$106.66	$113.43	$148.28
HMSA Facility/Professional Professional Modifier Low / Median / High Price $59.26 / $189.35 / $208.15	Professional		$59.26	$189.35	$208.15
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $64.95 / $68.02 / $69.72	Professional	26	$64.95	$68.02	$69.72
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $132.19 / $138.43 / $138.43	Professional	TC	$132.19	$138.43	$138.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $164.11 / $179.03 / $208.87	Professional		$164.11	$179.03	$208.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.37 / $60.41 / $70.48	Professional	26	$55.37	$60.41	$70.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $108.74 / $118.62 / $125.54	Professional	TC	$108.74	$118.62	$125.54
United Facility/Professional Professional Modifier Low / Median / High Price $89.24 / $201.41 / $261.56	Professional		$89.24	$201.41	$261.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.15 / $67.95 / $149.74	Professional	26	$32.15	$67.95	$149.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.08 / $133.44 / $177.47	Professional	TC	$57.08	$133.44	$177.47
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $174.62 / $232.82 / $297.69	Professional		$174.62	$232.82	$297.69
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $57.53 / $76.70 / $95.99	Professional	26	$57.53	$76.70	$95.99
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $117.09 / $156.11 / $201.70	Professional	TC	$117.09	$156.11	$201.70