Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.07 / $100.95 / $118.76	Facility	26	$89.07	$100.95	$118.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $174.65 / $268.31 / $299.29	Professional		$174.65	$268.31	$299.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.82 / $66.45 / $134.26	Professional	26	$56.82	$66.45	$134.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.04 / $186.96 / $232.83	Professional	TC	$134.04	$186.96	$232.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.26 / $105.26 / $105.26	Facility	26	$105.26	$105.26	$105.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $206.55 / $362.71 / $721.18	Professional		$206.55	$362.71	$721.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.68 / $80.28 / $127.76	Professional	26	$69.68	$80.28	$127.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.24 / $302.05 / $640.89	Professional	TC	$96.24	$302.05	$640.89
HMSA Facility/Professional Professional Modifier Low / Median / High Price $106.31 / $756.27 / $916.30	Professional		$106.31	$756.27	$916.30
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $116.53 / $122.02 / $125.07	Professional	26	$116.53	$122.02	$125.07
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $639.74 / $669.88 / $671.14	Professional	TC	$639.74	$669.88	$671.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $183.84 / $200.56 / $233.98	Professional		$183.84	$200.56	$233.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $96.77 / $105.56 / $123.16	Professional	26	$96.77	$105.56	$123.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.08 / $94.99 / $100.53	Professional	TC	$87.08	$94.99	$100.53
United Facility/Professional Professional Modifier Low / Median / High Price $98.20 / $225.63 / $285.52	Professional		$98.20	$225.63	$285.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.65 / $118.76 / $147.97	Professional	26	$55.65	$118.76	$147.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.55 / $106.87 / $181.10	Professional	TC	$42.55	$106.87	$181.10
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $206.92 / $306.45 / $860.00	Professional		$206.92	$306.45	$860.00
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $70.13 / $114.98 / $197.86	Professional	26	$70.13	$114.98	$197.86
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $98.16 / $222.57 / $735.17	Professional	TC	$98.16	$222.57	$735.17