Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.06 / $28.40 / $33.40	Facility	26	$25.06	$28.40	$33.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.81 / $98.91 / $220.59	Professional		$82.81	$98.91	$220.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.87 / $34.89 / $85.77	Professional	26	$22.87	$34.89	$85.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.92 / $73.51 / $182.37	Professional	TC	$59.92	$73.51	$182.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.92 / $28.92 / $28.92	Facility	26	$28.92	$28.92	$28.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.56 / $144.61 / $178.66	Professional		$81.56	$144.61	$178.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.40 / $29.82 / $36.36	Professional	26	$28.40	$29.82	$36.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.38 / $108.23 / $145.25	Professional	TC	$52.38	$108.23	$145.25
HMSA Facility/Professional Professional Modifier Low / Median / High Price $29.96 / $86.02 / $207.69	Professional		$29.96	$86.02	$207.69
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $32.83 / $34.38 / $35.25	Professional	26	$32.83	$34.38	$35.25
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $151.33 / $174.03 / $182.23	Professional	TC	$151.33	$174.03	$182.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $145.57 / $158.81 / $185.28	Professional		$145.57	$158.81	$185.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.23 / $29.70 / $34.65	Professional	26	$27.23	$29.70	$34.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $118.35 / $129.11 / $136.63	Professional	TC	$118.35	$129.11	$136.63
United Facility/Professional Professional Modifier Low / Median / High Price $70.38 / $178.66 / $220.65	Professional		$70.38	$178.66	$220.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.29 / $33.40 / $41.94	Professional	26	$15.29	$33.40	$41.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.09 / $145.25 / $178.71	Professional	TC	$55.09	$145.25	$178.71
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $105.71 / $166.06 / $338.22	Professional		$105.71	$166.06	$338.22
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $25.08 / $37.71 / $64.42	Professional	26	$25.08	$37.71	$64.42
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $74.86 / $126.97 / $273.79	Professional	TC	$74.86	$126.97	$273.79