Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.28 / $97.78 / $115.03	Facility	26	$86.28	$97.78	$115.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $321.02 / $446.18 / $547.46	Professional		$321.02	$446.18	$547.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.00 / $115.03 / $300.25	Professional	26	$82.00	$115.03	$300.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $230.22 / $282.57 / $480.15	Professional	TC	$230.22	$282.57	$480.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.30 / $390.38 / $495.75	Professional		$354.30	$390.38	$495.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.53 / $105.15 / $125.22	Professional	26	$94.53	$105.15	$125.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $254.37 / $285.23 / $367.94	Professional	TC	$254.37	$285.23	$367.94
HMSA Facility/Professional Professional Modifier Low / Median / High Price $137.72 / $846.77 / $996.60	Professional		$137.72	$846.77	$996.60
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $150.96 / $158.07 / $162.02	Professional	26	$150.96	$158.07	$162.02
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $695.81 / $728.60 / $728.86	Professional	TC	$695.81	$728.60	$728.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $363.55 / $396.60 / $462.70	Professional		$363.55	$396.60	$462.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.73 / $102.25 / $119.29	Professional	26	$93.73	$102.25	$119.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $269.82 / $294.35 / $311.52	Professional	TC	$269.82	$294.35	$311.52
United Facility/Professional Professional Modifier Low / Median / High Price $186.77 / $458.02 / $553.79	Professional		$186.77	$458.02	$553.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.11 / $115.03 / $144.36	Professional	26	$55.11	$115.03	$144.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.66 / $331.14 / $409.44	Professional	TC	$131.66	$331.14	$409.44
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $409.53 / $545.02 / $810.22	Professional		$409.53	$545.02	$810.22
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $95.33 / $131.52 / $220.46	Professional	26	$95.33	$131.52	$220.46
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $304.16 / $410.03 / $602.05	Professional	TC	$304.16	$410.03	$602.05