Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.08 / $79.42 / $93.43	Facility	26	$70.08	$79.42	$93.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $340.67 / $475.00 / $642.44	Professional		$340.67	$475.00	$642.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.51 / $99.16 / $154.00	Professional	26	$78.51	$99.16	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $197.86 / $335.00 / $368.50	Professional	TC	$197.86	$335.00	$368.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $252.69 / $500.86 / $585.77	Professional		$252.69	$500.86	$585.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.42 / $89.00 / $103.82	Professional	26	$79.42	$89.00	$103.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $172.18 / $383.69 / $496.77	Professional	TC	$172.18	$383.69	$496.77
HMSA Facility/Professional Professional Modifier Low / Median / High Price $91.09 / $731.33 / $904.48	Professional		$91.09	$731.33	$904.48
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $99.84 / $104.54 / $107.16	Professional	26	$99.84	$104.54	$107.16
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $631.49 / $661.25 / $661.25	Professional	TC	$631.49	$661.25	$661.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $227.80 / $248.51 / $289.93	Professional		$227.80	$248.51	$289.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.13 / $83.05 / $96.89	Professional	26	$76.13	$83.05	$96.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $151.66 / $165.46 / $175.11	Professional	TC	$151.66	$165.46	$175.11
United Facility/Professional Professional Modifier Low / Median / High Price $119.29 / $279.57 / $364.91	Professional		$119.29	$279.57	$364.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.05 / $99.53 / $117.45	Professional	26	$43.05	$99.53	$117.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.23 / $186.14 / $247.46	Professional	TC	$76.23	$186.14	$247.46
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $256.56 / $538.23 / $878.19	Professional		$256.56	$538.23	$878.19
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $75.76 / $113.54 / $179.42	Professional	26	$75.76	$113.54	$179.42
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $170.97 / $403.79 / $745.98	Professional	TC	$170.97	$403.79	$745.98