Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $30.90 / $36.31	Facility	26	$27.54	$30.90	$36.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $125.89 / $478.63	Professional		$61.66	$125.89	$478.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $30.90 / $95.50	Professional	26	$23.99	$30.90	$95.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $79.43 / $281.84	Professional	TC	$22.91	$79.43	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $114.82 / $218.78	Professional		$87.10	$114.82	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $34.67 / $60.26	Professional	26	$22.39	$34.67	$60.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $83.18 / $158.49	Professional	TC	$58.88	$83.18	$158.49
HMSA Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $147.91 / $151.36	Professional		$120.23	$147.91	$151.36
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $36.31 / $38.02	Professional	26	$35.48	$36.31	$38.02
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $107.15 / $112.20	Professional	TC	$107.15	$107.15	$112.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $131.83 / $165.96	Professional		$112.20	$131.83	$165.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $32.36 / $40.74	Professional	26	$28.18	$32.36	$40.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $100.00 / $123.03	Professional	TC	$85.11	$100.00	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $147.91 / $213.80	Professional		$120.23	$147.91	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $38.02 / $58.88	Professional	26	$31.62	$38.02	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $104.71 / $154.88	Professional	TC	$85.11	$104.71	$154.88
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $154.88 / $190.55	Professional		$107.15	$154.88	$190.55
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $39.81 / $60.26	Professional	26	$30.20	$39.81	$60.26
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $107.15 / $141.25	Professional	TC	$75.86	$107.15	$141.25