Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $97.72 / $114.82	Facility	26	$85.11	$97.72	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $371.54 / $1,659.59	Professional		$269.15	$371.54	$1,659.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $97.72 / $446.68	Professional	26	$81.28	$97.72	$446.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $245.47 / $562.34	Professional	TC	$169.82	$245.47	$562.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $501.19 / $691.83	Professional		$338.84	$501.19	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $107.15 / $190.55	Professional	26	$75.86	$107.15	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $407.38 / $537.03	Professional	TC	$239.88	$407.38	$537.03
HMSA Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $812.83 / $891.25	Professional		$660.69	$812.83	$891.25
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $120.23 / $125.89	Professional	26	$117.49	$120.23	$125.89
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $616.60 / $645.65	Professional	TC	$616.60	$616.60	$645.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $346.74 / $436.52	Professional		$295.12	$346.74	$436.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $102.33 / $125.89	Professional	26	$87.10	$102.33	$125.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $245.47 / $302.00	Professional	TC	$208.93	$245.47	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $446.68 / $724.44	Professional		$338.84	$446.68	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $120.23 / $186.21	Professional	26	$100.00	$120.23	$186.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $309.03 / $602.56	Professional	TC	$239.88	$309.03	$602.56
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $537.03 / $891.25	Professional		$363.08	$537.03	$891.25
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $128.82 / $194.98	Professional	26	$91.20	$128.82	$194.98
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $436.52 / $724.44	Professional	TC	$257.04	$436.52	$724.44