Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $19.95 / $23.44	Facility	26	$17.78	$19.95	$23.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $104.71 / $208.93	Professional		$69.18	$104.71	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $23.99 / $102.33	Professional	26	$15.14	$23.99	$102.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $87.10 / $131.83	Professional	TC	$56.23	$87.10	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $102.33 / $177.83	Professional		$79.43	$102.33	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $21.38 / $38.90	Professional	26	$15.49	$21.38	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $85.11 / $138.04	Professional	TC	$60.26	$85.11	$138.04
HMSA Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $154.88 / $169.82	Professional		$109.65	$154.88	$169.82
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $25.70 / $26.92	Professional	26	$25.12	$25.70	$26.92
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $123.03 / $128.82	Professional	TC	$123.03	$123.03	$128.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $131.83 / $154.88	Professional		$120.23	$131.83	$154.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $21.38 / $24.55	Professional	26	$19.50	$21.38	$24.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $109.65 / $128.82	Professional	TC	$102.33	$109.65	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $117.49 / $194.98	Professional		$104.71	$117.49	$194.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $22.91 / $36.31	Professional	26	$19.95	$22.91	$36.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $97.72 / $158.49	Professional	TC	$77.62	$97.72	$158.49
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $158.49 / $204.17	Professional		$125.89	$158.49	$204.17
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $25.70 / $44.67	Professional	26	$18.20	$25.70	$44.67
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $131.83 / $169.82	Professional	TC	$97.72	$131.83	$169.82