Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.70 / $82.39 / $96.93	Facility	26	$72.70	$82.39	$96.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $378.45 / $707.44	Professional		$171.00	$378.45	$707.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $77.61 / $110.72	Professional	26	$51.30	$77.61	$110.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $302.76 / $596.71	Professional	TC	$119.70	$302.76	$596.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $572.30 / $572.30 / $572.30	Professional		$572.30	$572.30	$572.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.10 / $93.10 / $112.63	Professional	26	$93.10	$93.10	$112.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $475.38 / $475.38 / $475.38	Professional	TC	$475.38	$475.38	$475.38
HMSA Facility/Professional Professional Modifier Low / Median / High Price $91.85 / $621.32 / $710.26	Professional		$91.85	$621.32	$710.26
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $95.09 / $99.57 / $102.06	Professional	26	$95.09	$99.57	$102.06
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $495.89 / $519.26 / $519.26	Professional	TC	$495.89	$519.26	$519.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $466.32 / $508.72 / $529.91	Professional		$466.32	$508.72	$529.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $78.98 / $86.16 / $89.75	Professional	26	$78.98	$86.16	$89.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $387.34 / $422.56 / $440.16	Professional	TC	$387.34	$422.56	$440.16
United Facility/Professional Professional Modifier Low / Median / High Price $518.03 / $572.30 / $775.30	Professional		$518.03	$572.30	$775.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $96.93 / $113.32 / $121.43	Professional	26	$96.93	$113.32	$121.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $404.71 / $475.38 / $653.87	Professional	TC	$404.71	$475.38	$653.87
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $525.41 / $759.78 / $1,199.69	Professional		$525.41	$759.78	$1,199.69
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $88.77 / $130.33 / $196.56	Professional	26	$88.77	$130.33	$196.56
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $436.64 / $640.79 / $1,003.13	Professional	TC	$436.64	$640.79	$1,003.13