Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $87.10 / $102.33	Facility	26	$77.62	$87.10	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $478.63 / $1,148.15	Professional		$251.19	$478.63	$1,148.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $120.23 / $426.58	Professional	26	$81.28	$120.23	$426.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $338.84 / $691.83	Professional	TC	$257.04	$338.84	$691.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $549.54 / $812.83	Professional		$416.87	$549.54	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $91.20 / $173.78	Professional	26	$64.57	$91.20	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $467.74 / $660.69	Professional	TC	$346.74	$467.74	$660.69
HMSA Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $870.96 / $977.24	Professional		$630.96	$870.96	$977.24
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $102.33 / $107.15	Professional	26	$100.00	$102.33	$107.15
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 $354.81 / $416.87 / $489.78	Professional		$354.81	$416.87	$489.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $91.20 / $107.15	Professional	26	$79.43	$91.20	$107.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $323.59 / $380.19	Professional	TC	$275.42	$323.59	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $562.34 / $794.33	Professional		$380.19	$562.34	$794.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $102.33 / $165.96	Professional	26	$89.13	$102.33	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $446.68 / $691.83	Professional	TC	$288.40	$446.68	$691.83
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $616.60 / $1,000.00	Professional		$446.68	$616.60	$1,000.00
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $112.20 / $169.82	Professional	26	$81.28	$112.20	$169.82
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $524.81 / $851.14	Professional	TC	$354.81	$524.81	$851.14