Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $87.10 / $102.33	Facility	26	$75.86	$87.10	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $346.74 / $1,380.38	Professional		$223.87	$346.74	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $269.15	Professional	26	$54.95	$83.18	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $213.80 / $436.52	Professional	TC	$151.36	$213.80	$436.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $354.81 / $512.86	Professional		$295.12	$354.81	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $85.11 / $154.88	Professional	26	$58.88	$85.11	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $281.84 / $407.38	Professional	TC	$218.78	$281.84	$407.38
HMSA Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $478.63 / $512.86	Professional		$338.84	$478.63	$512.86
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $102.33 / $107.15	Professional	26	$100.00	$102.33	$107.15
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $363.08 / $380.19	Professional	TC	$363.08	$363.08	$380.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $288.40 / $363.08	Professional		$245.47	$288.40	$363.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $91.20 / $112.20	Professional	26	$77.62	$91.20	$112.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $199.53 / $251.19	Professional	TC	$169.82	$199.53	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $407.38 / $512.86	Professional		$263.03	$407.38	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $102.33 / $165.96	Professional	26	$87.10	$102.33	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $302.00 / $426.58	Professional	TC	$177.83	$302.00	$426.58
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $426.58 / $776.25	Professional		$309.03	$426.58	$776.25
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $109.65 / $169.82	Professional	26	$77.62	$109.65	$169.82
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $323.59 / $630.96	Professional	TC	$213.80	$323.59	$630.96