Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.61 / $46.04 / $54.16	Facility	26	$40.61	$46.04	$54.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.43 / $191.09 / $648.00	Professional		$93.43	$191.09	$648.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $56.02 / $297.08	Professional	26	$36.61	$56.02	$297.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.82 / $69.69 / $128.80	Professional	TC	$56.82	$69.69	$128.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.25 / $46.25 / $46.25	Facility	26	$46.25	$46.25	$46.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.86 / $136.50 / $278.31	Professional		$85.86	$136.50	$278.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.72 / $50.82 / $93.21	Professional	26	$32.72	$50.82	$93.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.72 / $87.21 / $185.10	Professional	TC	$46.72	$87.21	$185.10
HMSA Facility/Professional Professional Modifier Low / Median / High Price $50.69 / $94.76 / $170.84	Professional		$50.69	$94.76	$170.84
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $54.29 / $56.85 / $58.26	Professional	26	$54.29	$56.85	$58.26
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $100.17 / $104.89 / $120.63	Professional	TC	$100.17	$104.89	$120.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $127.73 / $139.34 / $162.57	Professional		$127.73	$139.34	$162.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.13 / $48.14 / $56.17	Professional	26	$44.13	$48.14	$56.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.60 / $91.20 / $106.40	Professional	TC	$83.60	$91.20	$106.40
United Facility/Professional Professional Modifier Low / Median / High Price $115.13 / $156.76 / $190.13	Professional		$115.13	$156.76	$190.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.61 / $54.16 / $67.16	Professional	26	$40.61	$54.16	$67.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.81 / $102.60 / $122.97	Professional	TC	$71.81	$102.60	$122.97
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $104.68 / $170.96 / $299.39	Professional		$104.68	$170.96	$299.39
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $41.26 / $60.42 / $105.32	Professional	26	$41.26	$60.42	$105.32
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $63.40 / $106.59 / $194.07	Professional	TC	$63.40	$106.59	$194.07