Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.79 / $127.83 / $150.38	Facility	26	$112.79	$127.83	$150.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $335.52 / $400.05 / $578.22	Professional		$335.52	$400.05	$578.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.31 / $112.65 / $172.07	Professional	26	$100.31	$112.65	$172.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $235.21 / $288.69 / $406.13	Professional	TC	$235.21	$288.69	$406.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.94 / $128.94 / $128.94	Facility	26	$128.94	$128.94	$128.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $402.89 / $558.87 / $722.31	Professional		$402.89	$558.87	$722.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $118.73 / $131.34 / $163.38	Professional	26	$118.73	$131.34	$163.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $292.64 / $440.15 / $558.91	Professional	TC	$292.64	$440.15	$558.91
HMSA Facility/Professional Professional Modifier Low / Median / High Price $132.94 / $578.54 / $619.92	Professional		$132.94	$578.54	$619.92
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $145.72 / $152.60 / $156.41	Professional	26	$145.72	$152.60	$156.41
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $432.82 / $453.21 / $453.21	Professional	TC	$432.82	$453.21	$453.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $386.21 / $421.32 / $491.54	Professional		$386.21	$421.32	$491.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $122.54 / $133.68 / $155.96	Professional	26	$122.54	$133.68	$155.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $263.67 / $287.64 / $304.42	Professional	TC	$263.67	$287.64	$304.42
United Facility/Professional Professional Modifier Low / Median / High Price $206.16 / $473.99 / $616.57	Professional		$206.16	$473.99	$616.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.29 / $150.38 / $187.10	Professional	26	$71.29	$150.38	$187.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.87 / $323.60 / $489.38	Professional	TC	$134.87	$323.60	$489.38
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $432.73 / $527.15 / $864.00	Professional		$432.73	$527.15	$864.00
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $125.07 / $165.06 / $284.72	Professional	26	$125.07	$165.06	$284.72
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $270.58 / $381.07 / $593.41	Professional	TC	$270.58	$381.07	$593.41