Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.78 / $96.08 / $113.04	Facility	26	$84.78	$96.08	$113.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $475.00 / $613.42	Professional		$250.00	$475.00	$613.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $140.00 / $145.65	Professional	26	$62.50	$140.00	$145.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $335.00 / $484.30	Professional	TC	$187.50	$335.00	$484.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.37 / $97.37 / $97.37	Facility	26	$97.37	$97.37	$97.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $441.02 / $548.76 / $697.92	Professional		$441.02	$548.76	$697.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.63 / $101.14 / $124.13	Professional	26	$93.63	$101.14	$124.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $359.55 / $447.62 / $595.62	Professional	TC	$359.55	$447.62	$595.62
HMSA Facility/Professional Professional Modifier Low / Median / High Price $103.39 / $682.66 / $815.45	Professional		$103.39	$682.66	$815.45
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $113.33 / $118.67 / $121.63	Professional	26	$113.33	$118.67	$121.63
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $569.33 / $596.16 / $596.16	Professional	TC	$569.33	$596.16	$596.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $406.47 / $443.42 / $517.33	Professional		$406.47	$443.42	$517.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $92.10 / $100.48 / $117.22	Professional	26	$92.10	$100.48	$117.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $314.37 / $342.95 / $362.95	Professional	TC	$314.37	$342.95	$362.95
United Facility/Professional Professional Modifier Low / Median / High Price $210.86 / $498.85 / $656.96	Professional		$210.86	$498.85	$656.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.06 / $113.04 / $141.88	Professional	26	$52.06	$113.04	$141.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.80 / $385.82 / $515.07	Professional	TC	$158.80	$385.82	$515.07
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $457.91 / $645.03 / $1,050.78	Professional		$457.91	$645.03	$1,050.78
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $85.79 / $127.18 / $216.66	Professional	26	$85.79	$127.18	$216.66
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $354.38 / $535.12 / $844.49	Professional	TC	$354.38	$535.12	$844.49