Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $346.74 / $346.74 / $354.81	Facility		$346.74	$346.74	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $169.82 / $616.60	Professional		$61.66	$169.82	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $66.07 / $208.93	Professional	26	$33.88	$66.07	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $40.74 / $147.91	Professional	TC	$25.70	$40.74	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $100.00 / $331.13	Professional		$67.61	$100.00	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $93.33 / $117.49	Professional	26	$43.65	$93.33	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $147.91 / $213.80	Professional	TC	$38.02	$147.91	$213.80
HMSA Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $281.84 / $2,398.83	Professional		$138.04	$281.84	$2,398.83
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $117.49 / $123.03	Professional	26	$109.65	$117.49	$123.03
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $208.93 / $218.78	Professional	TC	$194.98	$208.93	$218.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $85.11 / $107.15	Professional		$77.62	$85.11	$107.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $44.67 / $56.23	Professional	26	$41.69	$44.67	$56.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $39.81 / $50.12	Professional	TC	$36.31	$39.81	$50.12
United Facility/Professional Facility Modifier Low / Median / High Price $1,071.52 / $1,071.52 / $1,071.52	Facility		$1,071.52	$1,071.52	$1,071.52
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $81.28 / $275.42	Professional		$61.66	$81.28	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $44.67 / $97.72	Professional	26	$35.48	$44.67	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $35.48 / $173.78	Professional	TC	$26.92	$35.48	$173.78
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $2,570.40 / $4,073.80	Professional		$63.10	$2,570.40	$4,073.80
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $51.29 / $138.04	Professional	26	$6.46	$51.29	$138.04
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $5.37 / $42.66 / $245.47	Professional	TC	$5.37	$42.66	$245.47