Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $70.79 / $83.18	Facility	26	$61.66	$70.79	$83.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $131.83 / $1,949.84	Professional		$102.33	$131.83	$1,949.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $83.18 / $933.25	Professional	26	$50.12	$83.18	$933.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $87.10 / $147.91	Professional	TC	$51.29	$87.10	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $181.97 / $275.42	Professional		$123.03	$181.97	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $69.18 / $125.89	Professional	26	$50.12	$69.18	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $102.33 / $147.91	Professional	TC	$74.13	$102.33	$147.91
HMSA Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $234.42 / $251.19	Professional		$194.98	$234.42	$251.19
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $81.28 / $83.18	Professional	26	$77.62	$81.28	$83.18
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $173.78 / $181.97	Professional	TC	$165.96	$173.78	$181.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $165.96 / $208.93	Professional		$144.54	$165.96	$208.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $75.86 / $89.13	Professional	26	$64.57	$75.86	$89.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $91.20 / $107.15	Professional	TC	$77.62	$91.20	$107.15
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $213.80 / $229.09	Professional		$117.49	$213.80	$229.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $79.43 / $97.72	Professional	26	$47.86	$79.43	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $114.82 / $151.36	Professional	TC	$69.18	$114.82	$151.36
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $208.93 / $363.08	Professional		$165.96	$208.93	$363.08
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $89.13 / $125.89	Professional	26	$66.07	$89.13	$125.89
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $112.20 / $239.88	Professional	TC	$91.20	$112.20	$239.88