Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.68 / $50.64 / $59.58	Facility	26	$44.68	$50.64	$59.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.97 / $174.28 / $233.94	Professional		$145.97	$174.28	$233.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.14 / $51.30 / $67.95	Professional	26	$42.14	$51.30	$67.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.82 / $127.40 / $165.99	Professional	TC	$103.82	$127.40	$165.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.84 / $51.84 / $51.84	Facility	26	$51.84	$51.84	$51.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $163.01 / $194.02 / $238.93	Professional		$163.01	$194.02	$238.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $54.26 / $66.20	Professional	26	$50.12	$54.26	$66.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.82 / $139.76 / $184.21	Professional	TC	$112.82	$139.76	$184.21
HMSA Facility/Professional Professional Modifier Low / Median / High Price $56.70 / $229.71 / $254.10	Professional		$56.70	$229.71	$254.10
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $60.72 / $63.58 / $65.17	Professional	26	$60.72	$63.58	$65.17
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $177.41 / $185.77 / $185.77	Professional	TC	$177.41	$185.77	$185.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $156.27 / $170.47 / $198.88	Professional		$156.27	$170.47	$198.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.54 / $52.96 / $61.78	Professional	26	$48.54	$52.96	$61.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $107.72 / $117.52 / $124.37	Professional	TC	$107.72	$117.52	$124.37
United Facility/Professional Professional Modifier Low / Median / High Price $82.90 / $215.61 / $243.11	Professional		$82.90	$215.61	$243.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.20 / $59.58 / $76.17	Professional	26	$29.20	$59.58	$76.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $132.21 / $166.94	Professional	TC	$53.70	$132.21	$166.94
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $175.99 / $220.77 / $306.01	Professional		$175.99	$220.77	$306.01
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $46.40 / $69.41 / $117.48	Professional	26	$46.40	$69.41	$117.48
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $118.38 / $160.44 / $224.24	Professional	TC	$118.38	$160.44	$224.24