Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.59 / $115.14 / $135.46	Facility	26	$101.59	$115.14	$135.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $475.00 / $522.50 / $611.94	Professional		$475.00	$522.50	$611.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $135.46 / $143.03 / $322.00	Professional	26	$135.46	$143.03	$322.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $348.53 / $456.99	Professional	TC	$335.00	$348.53	$456.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $484.95 / $846.36 / $1,101.48	Professional		$484.95	$846.36	$1,101.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $98.23 / $119.67 / $147.46	Professional	26	$98.23	$119.67	$147.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $342.29 / $748.14 / $981.80	Professional	TC	$342.29	$748.14	$981.80
HMSA Facility/Professional Professional Modifier Low / Median / High Price $121.17 / $1,382.64 / $1,790.11	Professional		$121.17	$1,382.64	$1,790.11
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $132.82 / $139.08 / $142.55	Professional	26	$132.82	$139.08	$142.55
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,249.82 / $1,308.71 / $1,309.21	Professional	TC	$1,249.82	$1,308.71	$1,309.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $406.97 / $443.96 / $517.96	Professional		$406.97	$443.96	$517.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $110.37 / $120.41 / $140.47	Professional	26	$110.37	$120.41	$140.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $296.58 / $323.56 / $342.43	Professional	TC	$296.58	$323.56	$342.43
United Facility/Professional Professional Modifier Low / Median / High Price $212.94 / $499.46 / $723.57	Professional		$212.94	$499.46	$723.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.79 / $135.46 / $169.16	Professional	26	$61.79	$135.46	$169.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.15 / $364.00 / $562.72	Professional	TC	$151.15	$364.00	$562.72
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $458.42 / $814.05 / $1,538.74	Professional		$458.42	$814.05	$1,538.74
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $100.89 / $150.97 / $257.37	Professional	26	$100.89	$150.97	$257.37
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $334.34 / $692.32 / $1,393.60	Professional	TC	$334.34	$692.32	$1,393.60