Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.22 / $43.32 / $50.96	Facility	26	$38.22	$43.32	$50.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.04 / $120.48 / $214.31	Professional		$101.04	$120.48	$214.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $52.77 / $58.40	Professional	26	$29.91	$52.77	$58.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.14 / $87.26 / $155.88	Professional	TC	$71.14	$87.26	$155.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $43.57 / $43.57	Facility	26	$43.57	$43.57	$43.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.87 / $129.07 / $181.38	Professional		$96.87	$129.07	$181.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.25 / $42.20 / $54.04	Professional	26	$38.25	$42.20	$54.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.43 / $90.82 / $133.30	Professional	TC	$58.43	$90.82	$133.30
HMSA Facility/Professional Professional Modifier Low / Median / High Price $44.93 / $97.52 / $196.76	Professional		$44.93	$97.52	$196.76
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $49.25 / $51.57 / $52.86	Professional	26	$49.25	$51.57	$52.86
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $127.20 / $146.28 / $153.16	Professional	TC	$127.20	$146.28	$153.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $142.69 / $155.68 / $181.62	Professional		$142.69	$155.68	$181.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.53 / $45.30 / $52.85	Professional	26	$41.53	$45.30	$52.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $101.18 / $110.38 / $116.81	Professional	TC	$101.18	$110.38	$116.81
United Facility/Professional Professional Modifier Low / Median / High Price $66.18 / $175.14 / $202.34	Professional		$66.18	$175.14	$202.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.47 / $50.96 / $63.89	Professional	26	$23.47	$50.96	$63.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.71 / $118.31 / $138.44	Professional	TC	$42.71	$118.31	$138.44
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $122.81 / $190.82 / $292.22	Professional		$122.81	$190.82	$292.22
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $34.31 / $55.37 / $83.90	Professional	26	$34.31	$55.37	$83.90
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $84.11 / $132.55 / $208.31	Professional	TC	$84.11	$132.55	$208.31