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 $371.54 / $457.09 / $851.14	Professional		$371.54	$457.09	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $112.20 / $173.78	Professional	26	$85.11	$112.20	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $338.84 / $562.34	Professional	TC	$257.04	$338.84	$562.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $537.03 / $851.14	Professional		$436.52	$537.03	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $107.15 / $190.55	Professional	26	$72.44	$107.15	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $446.68 / $660.69	Professional	TC	$363.08	$446.68	$660.69
HMSA Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $741.31 / $812.83	Professional		$141.25	$741.31	$812.83
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $117.49 / $123.03	Professional	26	$112.20	$117.49	$123.03
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $575.44 / $602.56	Professional	TC	$575.44	$575.44	$602.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $446.68 / $524.81	Professional		$380.19	$446.68	$524.81
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 $295.12 / $346.74 / $407.38	Professional	TC	$295.12	$346.74	$407.38
United Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $602.56 / $776.25	Professional		$407.38	$602.56	$776.25
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 $302.00 / $467.74 / $660.69	Professional	TC	$302.00	$467.74	$660.69
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $630.96 / $1,047.13	Professional		$478.63	$630.96	$1,047.13
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $125.89 / $190.55	Professional	26	$97.72	$125.89	$190.55
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $512.86 / $851.14	Professional	TC	$371.54	$512.86	$851.14