Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.49 / $93.49 / $109.98	Facility	26	$82.49	$93.49	$109.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $385.88 / $464.81 / $474.59	Professional		$385.88	$464.81	$474.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.65 / $116.76 / $230.30	Professional	26	$75.65	$116.76	$230.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $310.24 / $346.05 / $386.24	Professional	TC	$310.24	$346.05	$386.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $333.42 / $521.28 / $694.98	Professional		$333.42	$521.28	$694.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.71 / $97.07 / $120.28	Professional	26	$90.71	$97.07	$120.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $238.09 / $424.22 / $580.04	Professional	TC	$238.09	$424.22	$580.04
HMSA Facility/Professional Professional Modifier Low / Median / High Price $99.72 / $648.53 / $772.34	Professional		$99.72	$648.53	$772.34
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $109.30 / $114.45 / $117.32	Professional	26	$109.30	$114.45	$117.32
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $539.23 / $564.64 / $564.64	Professional	TC	$539.23	$564.64	$564.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $314.26 / $342.83 / $399.97	Professional		$314.26	$342.83	$399.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $89.62 / $97.76 / $114.06	Professional	26	$89.62	$97.76	$114.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $224.63 / $245.05 / $259.35	Professional	TC	$224.63	$245.05	$259.35
United Facility/Professional Professional Modifier Low / Median / High Price $169.34 / $385.68 / $500.45	Professional		$169.34	$385.68	$500.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.80 / $109.98 / $138.08	Professional	26	$52.80	$109.98	$138.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.54 / $275.68 / $366.99	Professional	TC	$116.54	$275.68	$366.99
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $353.97 / $590.82 / $846.47	Professional		$353.97	$590.82	$846.47
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $82.80 / $124.64 / $210.86	Professional	26	$82.80	$124.64	$210.86
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $253.22 / $487.87 / $699.66	Professional	TC	$253.22	$487.87	$699.66