Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $85.11 / $100.00	Facility	26	$75.86	$85.11	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $371.54 / $1,412.54	Professional		$194.98	$371.54	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $104.71 / $147.91	Professional	26	$64.57	$104.71	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $223.87 / $338.84	Professional	TC	$125.89	$223.87	$338.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $295.12 / $537.03	Professional		$204.17	$295.12	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $100.00 / $169.82	Professional	26	$63.10	$100.00	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $204.17 / $371.54	Professional	TC	$141.25	$204.17	$371.54
HMSA Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $724.44 / $812.83	Professional		$512.86	$724.44	$812.83
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $100.00 / $104.71	Professional	26	$97.72	$100.00	$104.71
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $562.34 / $588.84	Professional	TC	$562.34	$562.34	$588.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $281.84 / $331.13	Professional		$245.47	$281.84	$331.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $89.13 / $104.71	Professional	26	$77.62	$89.13	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $194.98 / $229.09	Professional	TC	$165.96	$194.98	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $501.19 / $1,258.93	Professional		$263.03	$501.19	$1,258.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $102.33 / $162.18	Professional	26	$87.10	$102.33	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $338.84 / $1,174.90	Professional	TC	$173.78	$338.84	$1,174.90
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $398.11 / $575.44	Professional		$302.00	$398.11	$575.44
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $109.65 / $134.90	Professional	26	$91.20	$109.65	$134.90
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $239.88 / $316.23	Professional	TC	$204.17	$239.88	$316.23