Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.16 / $34.18 / $40.22	Facility	26	$30.16	$34.18	$40.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $105.38 / $137.76 / $727.98	Professional		$105.38	$137.76	$727.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.77 / $41.92 / $112.51	Professional	26	$28.77	$41.92	$112.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.61 / $103.70 / $130.90	Professional	TC	$75.61	$103.70	$130.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.36 / $34.36 / $34.36	Facility	26	$34.36	$34.36	$34.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.06 / $131.29 / $197.55	Professional		$72.06	$131.29	$197.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.15 / $38.04 / $68.09	Professional	26	$24.15	$38.04	$68.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.01 / $88.91 / $153.47	Professional	TC	$41.01	$88.91	$153.47
HMSA Facility/Professional Professional Modifier Low / Median / High Price $37.33 / $127.49 / $152.29	Professional		$37.33	$127.49	$152.29
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $39.97 / $41.86 / $42.91	Professional	26	$39.97	$41.86	$42.91
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $105.46 / $110.43 / $110.43	Professional	TC	$105.46	$110.43	$110.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.80 / $128.51 / $149.93	Professional		$117.80	$128.51	$149.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.77 / $35.75 / $41.71	Professional	26	$32.77	$35.75	$41.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $85.03 / $92.76 / $108.22	Professional	TC	$85.03	$92.76	$108.22
United Facility/Professional Professional Modifier Low / Median / High Price $99.98 / $144.57 / $177.46	Professional		$99.98	$144.57	$177.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.28 / $40.22 / $50.15	Professional	26	$20.28	$40.22	$50.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.18 / $104.36 / $127.31	Professional	TC	$52.18	$104.36	$127.31
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $105.81 / $157.30 / $228.81	Professional		$105.81	$157.30	$228.81
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $30.30 / $46.28 / $76.91	Professional	26	$30.30	$46.28	$76.91
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $71.48 / $113.63 / $170.14	Professional	TC	$71.48	$113.63	$170.14