Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $33.88 / $40.74	Facility	26	$29.51	$33.88	$40.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $147.91 / $275.42	Professional		$75.86	$147.91	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $33.88 / $100.00	Professional	26	$20.89	$33.88	$100.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $81.28 / $123.03	Professional	TC	$56.23	$81.28	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $52.48 / $173.78	Professional		$47.86	$52.48	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $14.13 / $40.74	Professional	26	$13.49	$14.13	$40.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $38.02 / $134.90	Professional	TC	$34.67	$38.02	$134.90
HMSA Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $173.78 / $173.78	Professional		$141.25	$173.78	$173.78
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $38.02 / $63.10	Professional	26	$36.31	$38.02	$63.10
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $131.83 / $141.25	Professional	TC	$125.89	$131.83	$141.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $169.82 / $194.98	Professional		$154.88	$169.82	$194.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $38.90 / $45.71	Professional	26	$36.31	$38.90	$45.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $128.82 / $162.18	Professional	TC	$120.23	$128.82	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $134.90 / $234.42	Professional		$57.54	$134.90	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $37.15 / $56.23	Professional	26	$16.98	$37.15	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $95.50 / $177.83	Professional	TC	$40.74	$95.50	$177.83
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $204.17 / $281.84	Professional		$131.83	$204.17	$281.84
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $47.86 / $67.61	Professional	26	$30.90	$47.86	$67.61
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $151.36 / $213.80	Professional	TC	$102.33	$151.36	$213.80