Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.11 / $70.39 / $82.81	Facility	26	$62.11	$70.39	$82.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $137.58 / $220.51 / $1,254.45	Professional		$137.58	$220.51	$1,254.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.73 / $96.13 / $664.00	Professional	26	$59.73	$96.13	$664.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.40 / $99.96 / $199.92	Professional	TC	$73.40	$99.96	$199.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.93 / $181.90 / $198.58	Professional		$123.93	$181.90	$198.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.56 / $68.72 / $82.81	Professional	26	$49.56	$68.72	$82.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.38 / $102.78 / $129.86	Professional	TC	$74.38	$102.78	$129.86
HMSA Facility/Professional Professional Modifier Low / Median / High Price $72.47 / $235.89 / $252.97	Professional		$72.47	$235.89	$252.97
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $76.90 / $80.52 / $82.53	Professional	26	$76.90	$80.52	$82.53
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $164.69 / $172.45 / $172.45	Professional	TC	$164.69	$172.45	$172.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.78 / $161.69 / $188.64	Professional		$138.78	$161.69	$188.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.18 / $73.61 / $85.88	Professional	26	$63.18	$73.61	$85.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.59 / $88.08 / $91.75	Professional	TC	$75.59	$88.08	$91.75
United Facility/Professional Professional Modifier Low / Median / High Price $181.90 / $213.35 / $221.71	Professional		$181.90	$213.35	$221.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.36 / $82.81 / $97.82	Professional	26	$76.36	$82.81	$97.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $99.09 / $115.53 / $145.35	Professional	TC	$99.09	$115.53	$145.35
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $166.89 / $216.81 / $364.53	Professional		$166.89	$216.81	$364.53
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $66.75 / $89.95 / $146.26	Professional	26	$66.75	$89.95	$146.26
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $91.02 / $124.02 / $237.67	Professional	TC	$91.02	$124.02	$237.67