Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $97.72 / $114.82	Facility	26	$85.11	$97.72	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $363.08 / $1,000.00	Professional		$251.19	$363.08	$1,000.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $91.20 / $331.13	Professional	26	$67.61	$91.20	$331.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $223.87 / $478.63	Professional	TC	$173.78	$223.87	$478.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $501.19 / $691.83	Professional		$346.74	$501.19	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $107.15 / $190.55	Professional	26	$75.86	$107.15	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $407.38 / $549.54	Professional	TC	$251.19	$407.38	$549.54
HMSA Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $758.58 / $870.96	Professional		$537.03	$758.58	$870.96
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $120.23 / $125.89	Professional	26	$117.49	$120.23	$125.89
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $602.56 / $630.96	Professional	TC	$602.56	$602.56	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $346.74 / $426.58	Professional		$295.12	$346.74	$426.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $102.33 / $125.89	Professional	26	$87.10	$102.33	$125.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $245.47 / $302.00	Professional	TC	$208.93	$245.47	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $457.09 / $724.44	Professional		$363.08	$457.09	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $117.49 / $186.21	Professional	26	$100.00	$117.49	$186.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $323.59 / $602.56	Professional	TC	$269.15	$323.59	$602.56
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $562.34 / $870.96	Professional		$363.08	$562.34	$870.96
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $128.82 / $190.55	Professional	26	$89.13	$128.82	$190.55
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $478.63 / $707.95	Professional	TC	$257.04	$478.63	$707.95