Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,000.00 / $2,884.03 / $2,884.03	Facility		$1,000.00	$2,884.03	$2,884.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $426.58 / $549.54	Professional		$371.54	$426.58	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $134.90 / $223.87	Professional	26	$128.82	$134.90	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $281.84 / $389.05	Professional	TC	$234.42	$281.84	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $380.19 / $478.63	Professional		$346.74	$380.19	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $151.36 / $234.42	Professional	26	$125.89	$151.36	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $229.09 / $457.09	Professional	TC	$223.87	$229.09	$457.09
HMSA Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $616.60 / $2,511.89	Professional		$512.86	$616.60	$2,511.89
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $177.83 / $190.55	Professional	26	$169.82	$177.83	$190.55
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $501.19 / $537.03	Professional	TC	$478.63	$501.19	$537.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $467.74 / $575.44	Professional		$426.58	$467.74	$575.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $151.36 / $190.55	Professional	26	$138.04	$151.36	$190.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $309.03 / $389.05	Professional	TC	$281.84	$309.03	$389.05
United Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $1,096.48	Facility		$1,096.48	$1,096.48	$1,096.48
United Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $446.68 / $630.96	Professional		$389.05	$446.68	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $165.96 / $199.53	Professional	26	$123.03	$165.96	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $295.12 / $436.52	Professional	TC	$257.04	$295.12	$436.52
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $380.19 / $575.44	Professional		$70.79	$380.19	$575.44
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $109.65 / $165.96	Professional	26	$20.89	$109.65	$165.96
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $269.15 / $407.38	Professional	TC	$51.29	$269.15	$407.38