Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.79 / $39.44 / $46.40	Facility	26	$34.79	$39.44	$46.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.70 / $117.69 / $184.55	Professional		$98.70	$117.69	$184.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.04 / $36.20 / $53.13	Professional	26	$29.04	$36.20	$53.13
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $34.90 / $232.10 / $236.31	Professional	50	$34.90	$232.10	$236.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.88 / $77.93 / $126.90	Professional	TC	$60.88	$77.93	$126.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $39.72 / $39.72	Facility	26	$39.72	$39.72	$39.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.73 / $137.18 / $261.47	Professional		$79.73	$137.18	$261.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.86 / $45.37 / $78.20	Professional	26	$27.86	$45.37	$78.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.87 / $91.82 / $183.26	Professional	TC	$51.87	$91.82	$183.26
HMSA Facility/Professional Professional Modifier Low / Median / High Price $43.58 / $107.94 / $163.62	Professional		$43.58	$107.94	$163.62
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $44.81 / $46.92 / $51.27	Professional	26	$44.81	$46.92	$51.27
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $99.70 / $104.40 / $120.06	Professional	TC	$99.70	$104.40	$120.06
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.19 / $131.11 / $152.96	Professional		$120.19	$131.11	$152.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.81 / $41.24 / $48.12	Professional	26	$37.81	$41.24	$48.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.38 / $89.87 / $104.85	Professional	TC	$82.38	$89.87	$104.85
United Facility/Professional Professional Modifier Low / Median / High Price $108.99 / $147.50 / $180.50	Professional		$108.99	$147.50	$180.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.79 / $46.40 / $57.53	Professional	26	$34.79	$46.40	$57.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.81 / $101.10 / $122.97	Professional	TC	$71.81	$101.10	$122.97
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $140.75 / $174.12 / $279.38	Professional		$140.75	$174.12	$279.38
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $43.71 / $53.99 / $88.16	Professional	26	$43.71	$53.99	$88.16
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $97.03 / $120.13 / $191.22	Professional	TC	$97.03	$120.13	$191.22