Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.10 / $124.78 / $146.80	Facility	26	$110.10	$124.78	$146.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $155.13 / $216.84 / $787.18	Professional		$155.13	$216.84	$787.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.92 / $146.80 / $474.44	Professional	26	$90.92	$146.80	$474.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.19 / $88.89 / $110.68	Professional	TC	$58.19	$88.89	$110.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.15 / $224.95 / $561.59	Professional		$144.15	$224.95	$561.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.18 / $115.90 / $146.80	Professional	26	$84.18	$115.90	$146.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.46 / $76.63 / $445.69	Professional	TC	$49.46	$76.63	$445.69
HMSA Facility/Professional Professional Modifier Low / Median / High Price $129.93 / $733.25 / $811.11	Professional		$129.93	$733.25	$811.11
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $137.87 / $144.37 / $147.97	Professional	26	$137.87	$144.37	$147.97
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $566.29 / $592.98 / $596.32	Professional	TC	$566.29	$592.98	$596.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $156.41 / $182.22 / $212.59	Professional		$156.41	$182.22	$212.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.00 / $130.49 / $152.24	Professional	26	$112.00	$130.49	$152.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.39 / $51.72 / $53.88	Professional	TC	$44.39	$51.72	$53.88
United Facility/Professional Professional Modifier Low / Median / High Price $205.00 / $216.84 / $464.12	Professional		$205.00	$216.84	$464.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.69 / $146.80 / $172.53	Professional	26	$80.69	$146.80	$172.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.31 / $44.31 / $58.19	Professional	TC	$44.31	$44.31	$58.19
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $180.47 / $235.82 / $786.14	Professional		$180.47	$235.82	$786.14
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $113.07 / $159.47 / $256.33	Professional	26	$113.07	$159.47	$256.33
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $45.14 / $84.02 / $638.50	Professional	TC	$45.14	$84.02	$638.50