Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $95.50 / $112.20	Facility	26	$85.11	$95.50	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $416.87 / $851.14	Professional		$295.12	$416.87	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $117.49 / $478.63	Professional	26	$85.11	$117.49	$478.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $281.84 / $562.34	Professional	TC	$208.93	$281.84	$562.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $575.44 / $794.33	Professional		$363.08	$575.44	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $104.71 / $190.55	Professional	26	$72.44	$104.71	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $489.78 / $630.96	Professional	TC	$263.03	$489.78	$630.96
HMSA Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $891.25 / $977.24	Professional		$616.60	$891.25	$977.24
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $114.82 / $120.23	Professional	26	$112.20	$114.82	$120.23
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $676.08 / $676.08 / $707.95	Professional	TC	$676.08	$676.08	$707.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $354.81 / $416.87	Professional		$309.03	$354.81	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $100.00 / $117.49	Professional	26	$87.10	$100.00	$117.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $257.04 / $295.12	Professional	TC	$218.78	$257.04	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $478.63 / $851.14	Professional		$323.59	$478.63	$851.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $112.20 / $181.97	Professional	26	$97.72	$112.20	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $346.74 / $741.31	Professional	TC	$229.09	$346.74	$741.31
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $660.69 / $977.24	Professional		$380.19	$660.69	$977.24
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $128.82 / $186.21	Professional	26	$95.50	$128.82	$186.21
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $549.54 / $831.76	Professional	TC	$275.42	$549.54	$831.76