Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $32.36 / $38.02	Facility	26	$28.18	$32.36	$38.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $104.71 / $302.00	Professional		$69.18	$104.71	$302.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $33.11 / $117.49	Professional	26	$19.95	$33.11	$117.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $69.18 / $107.15	Professional	TC	$51.29	$69.18	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $100.00 / $186.21	Professional		$72.44	$100.00	$186.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $28.18 / $48.98	Professional	26	$21.38	$28.18	$48.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $75.86 / $138.04	Professional	TC	$47.86	$75.86	$138.04
HMSA Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $144.54 / $162.18	Professional		$93.33	$144.54	$162.18
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $38.02 / $39.81	Professional	26	$37.15	$38.02	$39.81
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $109.65 / $125.89	Professional	TC	$104.71	$109.65	$125.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $123.03 / $144.54	Professional		$114.82	$123.03	$144.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $33.88 / $39.81	Professional	26	$30.90	$33.88	$39.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $91.20 / $104.71	Professional	TC	$83.18	$91.20	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $128.82 / $194.98	Professional		$107.15	$128.82	$194.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $34.67 / $57.54	Professional	26	$28.84	$34.67	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $95.50 / $134.90	Professional	TC	$77.62	$95.50	$134.90
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $151.36 / $199.53	Professional		$97.72	$151.36	$199.53
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $40.74 / $48.98	Professional	26	$25.12	$40.74	$48.98
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $109.65 / $151.36	Professional	TC	$67.61	$109.65	$151.36