Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.44 / $95.70 / $112.59	Facility	26	$84.44	$95.70	$112.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $388.27 / $467.34 / $477.42	Professional		$388.27	$467.34	$477.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.34 / $91.56 / $128.65	Professional	26	$78.34	$91.56	$128.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $309.93 / $345.83 / $385.85	Professional	TC	$309.93	$345.83	$385.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.97 / $96.97 / $96.97	Facility	26	$96.97	$96.97	$96.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $345.63 / $478.56 / $635.83	Professional		$345.63	$478.56	$635.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.40 / $100.72 / $124.32	Professional	26	$83.40	$100.72	$124.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $247.23 / $395.16 / $511.51	Professional	TC	$247.23	$395.16	$511.51
HMSA Facility/Professional Professional Modifier Low / Median / High Price $102.30 / $715.15 / $863.71	Professional		$102.30	$715.15	$863.71
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $112.13 / $117.41 / $120.35	Professional	26	$112.13	$117.41	$120.35
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $603.02 / $631.42 / $631.42	Professional	TC	$603.02	$631.42	$631.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.18 / $344.93 / $402.42	Professional		$316.18	$344.93	$402.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.74 / $100.08 / $116.76	Professional	26	$91.74	$100.08	$116.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $224.43 / $244.84 / $259.12	Professional	TC	$224.43	$244.84	$259.12
United Facility/Professional Professional Modifier Low / Median / High Price $184.16 / $388.04 / $545.83	Professional		$184.16	$388.04	$545.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.10 / $112.59 / $141.35	Professional	26	$54.10	$112.59	$141.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.06 / $275.44 / $404.48	Professional	TC	$130.06	$275.44	$404.48
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $356.13 / $564.45 / $858.68	Professional		$356.13	$564.45	$858.68
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $85.84 / $125.76 / $216.34	Professional	26	$85.84	$125.76	$216.34
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $253.00 / $465.33 / $702.26	Professional	TC	$253.00	$465.33	$702.26