Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.77 / $53.70 / $63.10	Facility	26	$46.77	$53.70	$63.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $173.78 / $562.34	Professional		$104.71	$173.78	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $72.44 / $245.47	Professional	26	$40.74	$72.44	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $89.13 / $199.53	Professional	TC	$58.88	$89.13	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $147.91 / $295.12	Professional		$85.11	$147.91	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $56.23 / $107.15	Professional	26	$35.48	$56.23	$107.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $95.50 / $190.55	Professional	TC	$48.98	$95.50	$190.55
HMSA Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $134.90 / $173.78	Professional		$95.50	$134.90	$173.78
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $66.07 / $67.61	Professional	26	$63.10	$66.07	$67.61
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $107.15 / $112.20	Professional	TC	$102.33	$107.15	$112.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $151.36 / $177.83	Professional		$141.25	$151.36	$177.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $57.54 / $66.07	Professional	26	$52.48	$57.54	$66.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $95.50 / $112.20	Professional	TC	$87.10	$95.50	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $165.96 / $239.88	Professional		$125.89	$165.96	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $60.26 / $95.50	Professional	26	$46.77	$60.26	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $104.71 / $144.54	Professional	TC	$74.13	$104.71	$144.54
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $190.55 / $281.84	Professional		$138.04	$190.55	$281.84
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $104.71	Professional	26	$53.70	$70.79	$104.71
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $120.23 / $186.21	Professional	TC	$70.79	$120.23	$186.21