Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.17 / $43.26 / $50.90	Facility	26	$38.17	$43.26	$50.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.90 / $141.19 / $375.60	Professional		$50.90	$141.19	$375.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.82 / $50.90 / $129.59	Professional	26	$35.82	$50.90	$129.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.07 / $103.82 / $164.93	Professional	TC	$87.07	$103.82	$164.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.97 / $43.97 / $43.97	Facility	26	$43.97	$43.97	$43.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $146.81 / $154.99 / $197.73	Professional		$146.81	$154.99	$197.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.32 / $44.74 / $54.53	Professional	26	$42.32	$44.74	$54.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.07 / $111.73 / $144.19	Professional	TC	$102.07	$111.73	$144.19
HMSA Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $134.38 / $194.73	Professional		$45.71	$134.38	$194.73
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $49.68 / $52.02 / $53.78	Professional	26	$49.68	$52.02	$53.78
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $126.23 / $143.37 / $150.13	Professional	TC	$126.23	$143.37	$150.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $148.58 / $162.08 / $189.10	Professional		$148.58	$162.08	$189.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.47 / $45.24 / $52.78	Professional	26	$41.47	$45.24	$52.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $107.11 / $116.84 / $123.66	Professional	TC	$107.11	$116.84	$123.66
United Facility/Professional Professional Modifier Low / Median / High Price $73.63 / $182.34 / $226.43	Professional		$73.63	$182.34	$226.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.27 / $64.44 / $87.90	Professional	26	$41.27	$64.44	$87.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.95 / $131.44 / $161.99	Professional	TC	$49.95	$131.44	$161.99
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $170.82 / $221.90 / $347.25	Professional		$170.82	$221.90	$347.25
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $47.94 / $62.29 / $94.35	Professional	26	$47.94	$62.29	$94.35
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $122.87 / $161.05 / $252.91	Professional	TC	$122.87	$161.05	$252.91