Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $47.86 / $56.23	Facility	26	$42.66	$47.86	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $147.91 / $338.84	Professional		$100.00	$147.91	$338.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $42.66 / $112.20	Professional	26	$26.92	$42.66	$112.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $95.50 / $151.36	Professional	TC	$72.44	$95.50	$151.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $144.54 / $269.15	Professional		$104.71	$144.54	$269.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $42.66 / $72.44	Professional	26	$31.62	$42.66	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $107.15 / $194.98	Professional	TC	$66.07	$107.15	$194.98
HMSA Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $199.53 / $223.87	Professional		$131.83	$199.53	$223.87
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $56.23 / $58.88	Professional	26	$54.95	$56.23	$58.88
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $154.88 / $177.83	Professional	TC	$147.91	$154.88	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $177.83 / $204.17	Professional		$162.18	$177.83	$204.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $50.12 / $58.88	Professional	26	$46.77	$50.12	$58.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $125.89 / $147.91	Professional	TC	$114.82	$125.89	$147.91
United Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $186.21 / $281.84	Professional		$151.36	$186.21	$281.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $52.48 / $85.11	Professional	26	$43.65	$52.48	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $134.90 / $190.55	Professional	TC	$107.15	$134.90	$190.55
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $208.93 / $288.40	Professional		$141.25	$208.93	$288.40
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $60.26 / $72.44	Professional	26	$38.02	$60.26	$72.44
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $151.36 / $213.80	Professional	TC	$95.50	$151.36	$213.80