Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.05 / $85.05 / $100.06	Facility	26	$75.05	$85.05	$100.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $433.43 / $591.19 / $2,690.00	Professional		$433.43	$591.19	$2,690.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.62 / $78.65 / $273.58	Professional	26	$67.62	$78.65	$273.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $267.02 / $414.12 / $653.23	Professional	TC	$267.02	$414.12	$653.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $474.29 / $474.29 / $790.66	Professional		$474.29	$474.29	$790.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.65 / $88.65 / $109.76	Professional	26	$88.65	$88.65	$109.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $385.64 / $385.64 / $680.89	Professional	TC	$385.64	$385.64	$680.89
HMSA Facility/Professional Professional Modifier Low / Median / High Price $197.17 / $932.91 / $1,036.75	Professional		$197.17	$932.91	$1,036.75
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $163.01 / $170.69 / $174.96	Professional	26	$163.01	$170.69	$174.96
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $723.84 / $757.95 / $757.95	Professional	TC	$723.84	$757.95	$757.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $505.66 / $551.63 / $574.61	Professional		$505.66	$551.63	$574.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.53 / $88.94 / $92.65	Professional	26	$81.53	$88.94	$92.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $424.13 / $462.68 / $481.96	Professional	TC	$424.13	$462.68	$481.96
United Facility/Professional Professional Modifier Low / Median / High Price $620.58 / $815.83 / $853.35	Professional		$620.58	$815.83	$853.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $100.06 / $125.00 / $153.22	Professional	26	$100.06	$125.00	$153.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $319.41 / $520.52 / $700.12	Professional	TC	$319.41	$520.52	$700.12
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $538.10 / $727.31 / $1,293.77	Professional		$538.10	$727.31	$1,293.77
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $84.29 / $109.71 / $190.97	Professional	26	$84.29	$109.71	$190.97
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $463.54 / $598.72 / $1,102.80	Professional	TC	$463.54	$598.72	$1,102.80