Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.41 / $58.27 / $68.55	Facility	26	$51.41	$58.27	$68.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.39 / $112.58 / $264.64	Professional		$63.39	$112.58	$264.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $50.78 / $170.98	Professional	26	$40.96	$50.78	$170.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.71 / $54.64 / $84.67	Professional	TC	$29.71	$54.64	$84.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.00 / $137.52 / $213.89	Professional		$82.00	$137.52	$213.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.15 / $52.51 / $68.55	Professional	26	$38.15	$52.51	$68.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.84 / $70.09 / $161.38	Professional	TC	$43.84	$70.09	$161.38
HMSA Facility/Professional Professional Modifier Low / Median / High Price $60.62 / $269.14 / $293.36	Professional		$60.62	$269.14	$293.36
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $64.33 / $67.36 / $69.04	Professional	26	$64.33	$67.36	$69.04
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $204.82 / $214.47 / $215.14	Professional	TC	$204.82	$214.47	$215.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $103.79 / $120.92 / $141.08	Professional		$103.79	$120.92	$141.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.30 / $60.94 / $71.09	Professional	26	$52.30	$60.94	$71.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.48 / $59.98 / $62.48	Professional	TC	$51.48	$59.98	$62.48
United Facility/Professional Professional Modifier Low / Median / High Price $136.04 / $157.25 / $198.56	Professional		$136.04	$157.25	$198.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.12 / $68.55 / $81.34	Professional	26	$59.12	$68.55	$81.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.02 / $67.47 / $139.44	Professional	TC	$41.02	$67.47	$139.44
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $168.78 / $307.29	Professional		$114.82	$168.78	$307.29
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $51.38 / $74.47 / $120.64	Professional	26	$51.38	$74.47	$120.64
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $61.33 / $81.47 / $231.33	Professional	TC	$61.33	$81.47	$231.33