Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.12 / $95.33 / $112.16	Facility	26	$84.12	$95.33	$112.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $475.00 / $494.18 / $613.72	Professional		$475.00	$494.18	$613.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.16 / $140.00 / $154.00	Professional	26	$128.16	$140.00	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $348.53 / $485.57	Professional	TC	$335.00	$348.53	$485.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $439.33 / $547.54 / $696.09	Professional		$439.33	$547.54	$696.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.52 / $99.92 / $123.19	Professional	26	$92.52	$99.92	$123.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $361.71 / $447.62 / $595.14	Professional	TC	$361.71	$447.62	$595.14
HMSA Facility/Professional Professional Modifier Low / Median / High Price $102.13 / $681.27 / $815.45	Professional		$102.13	$681.27	$815.45
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $111.94 / $117.21 / $120.15	Professional	26	$111.94	$117.21	$120.15
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 $406.57 / $443.53 / $517.45	Professional		$406.57	$443.53	$517.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.39 / $99.70 / $116.31	Professional	26	$91.39	$99.70	$116.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $315.18 / $343.84 / $363.89	Professional	TC	$315.18	$343.84	$363.89
United Facility/Professional Professional Modifier Low / Median / High Price $211.40 / $498.97 / $658.97	Professional		$211.40	$498.97	$658.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.65 / $112.16 / $140.81	Professional	26	$51.65	$112.16	$140.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $159.75 / $386.82 / $518.16	Professional	TC	$159.75	$386.82	$518.16
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $458.03 / $645.79 / $1,056.71	Professional		$458.03	$645.79	$1,056.71
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $84.77 / $126.78 / $215.00	Professional	26	$84.77	$126.78	$215.00
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $355.30 / $544.34 / $844.49	Professional	TC	$355.30	$544.34	$844.49