Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.89 / $30.48 / $35.86	Facility	26	$26.89	$30.48	$35.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.14 / $97.57 / $234.94	Professional		$88.14	$97.57	$234.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.93 / $23.64 / $41.22	Professional	26	$18.93	$23.64	$41.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.20 / $73.93 / $193.71	Professional	TC	$69.20	$73.93	$193.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.37 / $30.37 / $30.37	Facility	26	$30.37	$30.37	$30.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.16 / $129.88 / $190.13	Professional		$114.16	$129.88	$190.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.99 / $30.74 / $38.27	Professional	26	$29.99	$30.74	$38.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.18 / $96.72 / $154.28	Professional	TC	$84.18	$96.72	$154.28
HMSA Facility/Professional Professional Modifier Low / Median / High Price $30.74 / $153.11 / $196.65	Professional		$30.74	$153.11	$196.65
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $33.70 / $35.29 / $36.17	Professional	26	$33.70	$35.29	$36.17
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $153.26 / $160.47 / $160.47	Professional	TC	$153.26	$160.47	$160.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.91 / $169.01 / $197.18	Professional		$154.91	$169.01	$197.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.22 / $31.87 / $37.18	Professional	26	$29.22	$31.87	$37.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.71 / $137.13 / $145.13	Professional	TC	$125.71	$137.13	$145.13
United Facility/Professional Professional Modifier Low / Median / High Price $65.66 / $190.13 / $204.83	Professional		$65.66	$190.13	$204.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.91 / $35.86 / $43.46	Professional	26	$15.91	$35.86	$43.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.75 / $126.23 / $161.37	Professional	TC	$49.75	$126.23	$161.37
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $126.77 / $203.59 / $263.14	Professional		$126.77	$203.59	$263.14
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $26.36 / $39.78 / $66.22	Professional	26	$26.36	$39.78	$66.22
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $96.38 / $157.83 / $202.25	Professional	TC	$96.38	$157.83	$202.25