Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $57.54 / $67.61	Facility	26	$51.29	$57.54	$67.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $218.78 / $691.83	Professional		$141.25	$218.78	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $57.54 / $204.17	Professional	26	$48.98	$57.54	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $128.82 / $281.84	Professional	TC	$85.11	$128.82	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $251.19 / $354.81	Professional		$165.96	$251.19	$354.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $63.10 / $114.82	Professional	26	$43.65	$63.10	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $194.98 / $234.42	Professional	TC	$104.71	$194.98	$234.42
HMSA Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $389.05 / $426.58	Professional		$269.15	$389.05	$426.58
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $69.18 / $72.44	Professional	26	$67.61	$69.18	$72.44
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $302.00 / $316.23	Professional	TC	$302.00	$302.00	$316.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $173.78 / $218.78	Professional		$147.91	$173.78	$218.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $60.26 / $75.86	Professional	26	$52.48	$60.26	$75.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $112.20 / $141.25	Professional	TC	$97.72	$112.20	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $218.78 / $371.54	Professional		$158.49	$218.78	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $67.61 / $112.20	Professional	26	$60.26	$67.61	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $134.90 / $302.00	Professional	TC	$100.00	$134.90	$302.00
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $275.42 / $501.19	Professional		$186.21	$275.42	$501.19
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $114.82	Professional	26	$57.54	$77.62	$114.82
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $213.80 / $398.11	Professional	TC	$120.23	$213.80	$398.11