Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.48 / $105.95 / $129.84	Facility	26	$93.48	$105.95	$129.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.62 / $219.57 / $344.00	Professional		$171.62	$219.57	$344.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.25 / $110.56 / $428.85	Professional	26	$88.25	$110.56	$428.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.08 / $83.15 / $121.40	Professional	TC	$67.08	$83.15	$121.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.36 / $242.61 / $251.51	Professional		$185.36	$242.61	$251.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.95 / $130.06 / $137.08	Professional	26	$105.95	$130.06	$137.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.42 / $112.22 / $114.43	Professional	TC	$79.42	$112.22	$114.43
HMSA Facility/Professional Professional Modifier Low / Median / High Price $100.26 / $148.13 / $254.71	Professional		$100.26	$148.13	$254.71
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $129.94 / $136.07 / $139.47	Professional	26	$129.94	$136.07	$139.47
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $110.05 / $115.24 / $115.24	Professional	TC	$110.05	$115.24	$115.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.90 / $218.08 / $254.42	Professional		$199.90	$218.08	$254.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $114.26 / $124.64 / $145.41	Professional	26	$114.26	$124.64	$145.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $85.65 / $93.43 / $109.00	Professional	TC	$85.65	$93.43	$109.00
United Facility/Professional Professional Modifier Low / Median / High Price $185.36 / $227.16 / $318.02	Professional		$185.36	$227.16	$318.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $103.62 / $129.84 / $173.37	Professional	26	$103.62	$129.84	$173.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.00 / $94.19 / $144.65	Professional	TC	$74.00	$94.19	$144.65
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $148.41 / $228.09 / $262.89	Professional		$148.41	$228.09	$262.89
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $80.91 / $123.51 / $143.32	Professional	26	$80.91	$123.51	$143.32
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $67.50 / $104.57 / $119.57	Professional	TC	$67.50	$104.57	$119.57