Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.51 / $85.58 / $100.68	Facility	26	$75.51	$85.58	$100.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $391.85 / $494.18 / $644.79	Professional		$391.85	$494.18	$644.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.51 / $115.34 / $154.00	Professional	26	$104.51	$115.34	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $276.50 / $335.00 / $368.50	Professional	TC	$276.50	$335.00	$368.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.45 / $86.45 / $86.45	Facility	26	$86.45	$86.45	$86.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $270.33 / $281.83 / $356.60	Professional		$270.33	$281.83	$356.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.57 / $91.85 / $110.69	Professional	26	$82.57	$91.85	$110.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $187.21 / $189.99 / $244.73	Professional	TC	$187.21	$189.99	$244.73
HMSA Facility/Professional Professional Modifier Low / Median / High Price $89.87 / $663.41 / $809.13	Professional		$89.87	$663.41	$809.13
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $98.50 / $103.14 / $105.73	Professional	26	$98.50	$103.14	$105.73
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $564.91 / $591.53 / $591.53	Professional	TC	$564.91	$591.53	$591.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $261.50 / $285.27 / $332.82	Professional		$261.50	$285.27	$332.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $82.04 / $89.50 / $104.41	Professional	26	$82.04	$89.50	$104.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $179.47 / $195.78 / $207.20	Professional	TC	$179.47	$195.78	$207.20
United Facility/Professional Professional Modifier Low / Median / High Price $137.97 / $320.94 / $787.56	Professional		$137.97	$320.94	$787.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.30 / $100.68 / $126.47	Professional	26	$46.30	$100.68	$126.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.68 / $297.62 / $679.37	Professional	TC	$91.68	$297.62	$679.37
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $301.88 / $409.94 / $575.00	Professional		$301.88	$409.94	$575.00
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $92.22 / $109.84 / $135.74	Professional	26	$92.22	$109.84	$135.74
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $202.31 / $255.68 / $319.44	Professional	TC	$202.31	$255.68	$319.44