Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $117.49 / $138.04	Facility	26	$102.33	$117.49	$138.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $478.63 / $1,445.44	Professional		$275.42	$478.63	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $138.04 / $575.44	Professional	26	$81.28	$138.04	$575.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $323.59 / $524.81	Professional	TC	$218.78	$323.59	$524.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $575.44 / $812.83	Professional		$446.68	$575.44	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $138.04 / $229.09	Professional	26	$87.10	$138.04	$229.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $457.09 / $645.65	Professional	TC	$323.59	$457.09	$645.65
HMSA Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $794.33 / $891.25	Professional		$660.69	$794.33	$891.25
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $138.04 / $144.54	Professional	26	$134.90	$138.04	$144.54
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $616.60 / $645.65	Professional	TC	$616.60	$616.60	$645.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $501.19 / $630.96	Professional		$426.58	$501.19	$630.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $123.03 / $154.88	Professional	26	$104.71	$123.03	$154.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $380.19 / $467.74	Professional	TC	$323.59	$380.19	$467.74
United Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $588.84 / $851.14	Professional		$457.09	$588.84	$851.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $151.36 / $223.87	Professional	26	$120.23	$151.36	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $426.58 / $660.69	Professional	TC	$338.84	$426.58	$660.69
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $676.08 / $933.25	Professional		$512.86	$676.08	$933.25
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $147.91 / $263.03	Professional	26	$102.33	$147.91	$263.03
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $537.03 / $776.25	Professional	TC	$389.05	$537.03	$776.25