Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.72 / $55.22 / $64.95	Facility	26	$48.72	$55.22	$64.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.45 / $130.80 / $267.51	Professional		$109.45	$130.80	$267.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $34.10 / $74.41	Professional	26	$29.91	$34.10	$74.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.54 / $97.58 / $193.09	Professional	TC	$79.54	$97.58	$193.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.98 / $55.98 / $55.98	Facility	26	$55.98	$55.98	$55.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.92 / $171.08 / $243.05	Professional		$106.92	$171.08	$243.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.92 / $42.20 / $69.19	Professional	26	$37.92	$42.20	$69.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.48 / $130.71 / $170.87	Professional	TC	$68.48	$130.71	$170.87
HMSA Facility/Professional Professional Modifier Low / Median / High Price $58.04 / $122.93 / $246.46	Professional		$58.04	$122.93	$246.46
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $63.62 / $66.62 / $68.28	Professional	26	$63.62	$66.62	$68.28
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $157.60 / $181.25 / $189.79	Professional	TC	$157.60	$181.25	$189.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $178.23 / $194.44 / $226.84	Professional		$178.23	$194.44	$226.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.93 / $57.74 / $67.37	Professional	26	$52.93	$57.74	$67.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.30 / $136.69 / $144.66	Professional	TC	$125.30	$136.69	$144.66
United Facility/Professional Professional Modifier Low / Median / High Price $84.70 / $218.74 / $259.39	Professional		$84.70	$218.74	$259.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.99 / $64.95 / $81.92	Professional	26	$29.99	$64.95	$81.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.71 / $153.78 / $177.47	Professional	TC	$54.71	$153.78	$177.47
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $147.30 / $224.80 / $375.34	Professional		$147.30	$224.80	$375.34
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $36.93 / $61.63 / $83.96	Professional	26	$36.93	$61.63	$83.96
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $98.21 / $153.80 / $285.94	Professional	TC	$98.21	$153.80	$285.94