Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.46 / $53.78 / $63.27	Facility	26	$47.46	$53.78	$63.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.55 / $231.79 / $773.00	Professional		$130.55	$231.79	$773.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $69.67 / $247.94	Professional	26	$42.60	$69.67	$247.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.12 / $107.91 / $163.66	Professional	TC	$84.12	$107.91	$163.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.96 / $53.96 / $53.96	Facility	26	$53.96	$53.96	$53.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.50 / $175.95 / $345.32	Professional		$105.50	$175.95	$345.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.01 / $59.67 / $107.81	Professional	26	$38.01	$59.67	$107.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.48 / $112.35 / $237.50	Professional	TC	$67.48	$112.35	$237.50
HMSA Facility/Professional Professional Modifier Low / Median / High Price $58.05 / $153.11 / $206.35	Professional		$58.05	$153.11	$206.35
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $62.16 / $65.09 / $66.72	Professional	26	$62.16	$65.09	$66.72
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $127.69 / $133.71 / $149.35	Professional	TC	$127.69	$133.71	$149.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $157.85 / $172.20 / $200.90	Professional		$157.85	$172.20	$200.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.56 / $56.24 / $65.62	Professional	26	$51.56	$56.24	$65.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $106.28 / $115.94 / $135.27	Professional	TC	$106.28	$115.94	$135.27
United Facility/Professional Professional Modifier Low / Median / High Price $142.55 / $193.73 / $235.61	Professional		$142.55	$193.73	$235.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.46 / $63.27 / $78.56	Professional	26	$47.46	$63.27	$78.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.66 / $130.44 / $157.04	Professional	TC	$91.66	$130.44	$157.04
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $152.22 / $216.10 / $369.84	Professional		$152.22	$216.10	$369.84
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $47.23 / $72.04 / $121.67	Professional	26	$47.23	$72.04	$121.67
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $96.38 / $147.10 / $248.17	Professional	TC	$96.38	$147.10	$248.17