Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.87 / $34.99 / $41.16	Facility	26	$30.87	$34.99	$41.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.59 / $123.30 / $488.00	Professional		$82.59	$123.30	$488.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.64 / $63.00 / $180.00	Professional	26	$27.64	$63.00	$180.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.90 / $67.39 / $94.12	Professional	TC	$50.90	$67.39	$94.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.11 / $35.11 / $35.11	Facility	26	$35.11	$35.11	$35.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.12 / $109.32 / $203.35	Professional		$63.12	$109.32	$203.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.68 / $38.93 / $69.73	Professional	26	$24.68	$38.93	$69.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.44 / $70.39 / $133.61	Professional	TC	$38.44	$70.39	$133.61
HMSA Facility/Professional Professional Modifier Low / Median / High Price $38.36 / $103.48 / $118.67	Professional		$38.36	$103.48	$118.67
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $41.09 / $43.03 / $44.10	Professional	26	$41.09	$43.03	$44.10
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $72.23 / $75.64 / $75.64	Professional	TC	$72.23	$75.64	$75.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $94.66 / $103.26 / $120.47	Professional		$94.66	$103.26	$120.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $36.59 / $42.69	Professional	26	$33.54	$36.59	$42.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $61.12 / $66.67 / $77.78	Professional	TC	$61.12	$66.67	$77.78
United Facility/Professional Professional Modifier Low / Median / High Price $85.53 / $116.17 / $140.84	Professional		$85.53	$116.17	$140.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.87 / $41.16 / $51.32	Professional	26	$30.87	$41.16	$51.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.33 / $75.01 / $89.52	Professional	TC	$52.33	$75.01	$89.52
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $78.80 / $130.65 / $190.16	Professional		$78.80	$130.65	$190.16
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $27.84 / $46.25 / $68.42	Professional	26	$27.84	$46.25	$68.42
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $50.97 / $84.39 / $128.44	Professional	TC	$50.97	$84.39	$128.44