Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.03 / $53.30 / $62.71	Facility	26	$47.03	$53.30	$62.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.92 / $171.00 / $272.42	Professional		$64.92	$171.00	$272.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.49 / $64.92 / $89.59	Professional	26	$44.49	$64.92	$89.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.87 / $177.61 / $221.14	Professional	TC	$141.87	$177.61	$221.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.16 / $241.98 / $319.77	Professional		$189.16	$241.98	$319.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.30 / $60.65 / $69.16	Professional	26	$53.30	$60.65	$69.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $126.55 / $191.95 / $258.39	Professional	TC	$126.55	$191.95	$258.39
HMSA Facility/Professional Professional Modifier Low / Median / High Price $61.92 / $319.63 / $360.60	Professional		$61.92	$319.63	$360.60
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $67.87 / $71.06 / $72.84	Professional	26	$67.87	$71.06	$72.84
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $251.76 / $263.62 / $263.62	Professional	TC	$251.76	$263.62	$263.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $155.13 / $169.25 / $197.46	Professional		$155.13	$169.25	$197.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.10 / $55.74 / $65.03	Professional	26	$51.10	$55.74	$65.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.04 / $113.50 / $120.12	Professional	TC	$104.04	$113.50	$120.12
United Facility/Professional Professional Modifier Low / Median / High Price $88.69 / $190.40 / $263.73	Professional		$88.69	$190.40	$263.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.92 / $79.11 / $379.64	Professional	26	$55.92	$79.11	$379.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.47 / $127.68 / $188.59	Professional	TC	$58.47	$127.68	$188.59
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $174.73 / $287.52 / $497.32	Professional		$174.73	$287.52	$497.32
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $47.71 / $76.47 / $121.05	Professional	26	$47.71	$76.47	$121.05
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $117.28 / $229.59 / $397.40	Professional	TC	$117.28	$229.59	$397.40