Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $67.61 / $79.43	Facility	26	$58.88	$67.61	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $302.00 / $724.44	Professional		$208.93	$302.00	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $69.18 / $302.00	Professional	26	$54.95	$69.18	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $213.80 / $501.19	Professional	TC	$144.54	$213.80	$501.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $389.05 / $524.81	Professional		$288.40	$389.05	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $79.43 / $144.54	Professional	26	$54.95	$79.43	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $323.59 / $446.68	Professional	TC	$208.93	$323.59	$446.68
HMSA Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $575.44 / $645.65	Professional		$107.15	$575.44	$645.65
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $87.10 / $91.20	Professional	26	$85.11	$87.10	$91.20
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $446.68 / $467.74	Professional	TC	$446.68	$446.68	$467.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $257.04 / $323.59	Professional		$223.87	$257.04	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $70.79 / $87.10	Professional	26	$60.26	$70.79	$87.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $186.21 / $234.42	Professional	TC	$162.18	$186.21	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $407.38 / $562.34	Professional		$234.42	$407.38	$562.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $87.10 / $131.83	Professional	26	$67.61	$87.10	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $302.00 / $478.63	Professional	TC	$165.96	$302.00	$478.63
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $436.52 / $794.33	Professional		$275.42	$436.52	$794.33
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $97.72 / $144.54	Professional	26	$72.44	$97.72	$144.54
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $363.08 / $676.08	Professional	TC	$204.17	$363.08	$676.08