Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.90 / $50.89 / $59.87	Facility	26	$44.90	$50.89	$59.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.06 / $162.68 / $179.45	Professional		$145.06	$162.68	$179.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.71 / $17.39 / $67.92	Professional	26	$15.71	$17.39	$67.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.75 / $129.36 / $161.07	Professional	TC	$94.75	$129.36	$161.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.72 / $52.72 / $52.72	Facility	26	$52.72	$52.72	$52.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.69 / $218.17 / $663.07	Professional		$111.69	$218.17	$663.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.34 / $22.18 / $59.87	Professional	26	$19.34	$22.18	$59.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.86 / $181.57 / $640.89	Professional	TC	$70.86	$181.57	$640.89
HMSA Facility/Professional Professional Modifier Low / Median / High Price $53.52 / $700.79 / $916.30	Professional		$53.52	$700.79	$916.30
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $58.66 / $61.42 / $62.97	Professional	26	$58.66	$61.42	$62.97
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $639.74 / $669.88 / $670.84	Professional	TC	$639.74	$669.88	$670.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $110.31 / $120.34 / $140.38	Professional		$110.31	$120.34	$140.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.79 / $53.22 / $62.09	Professional	26	$48.79	$53.22	$62.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $61.52 / $67.12 / $71.03	Professional	TC	$61.52	$67.12	$71.03
United Facility/Professional Professional Modifier Low / Median / High Price $59.99 / $135.38 / $178.02	Professional		$59.99	$135.38	$178.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.21 / $59.87 / $75.48	Professional	26	$26.21	$59.87	$75.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.66 / $75.51 / $103.40	Professional	TC	$31.66	$75.51	$103.40
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $124.19 / $175.23 / $752.75	Professional		$124.19	$175.23	$752.75
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $19.64 / $35.52 / $70.68	Professional	26	$19.64	$35.52	$70.68
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $69.34 / $143.75 / $727.01	Professional	TC	$69.34	$143.75	$727.01