Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $114.82 / $134.90	Facility	26	$102.33	$114.82	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $478.63 / $1,479.11	Professional		$371.54	$478.63	$1,479.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $141.25 / $562.34	Professional	26	$102.33	$141.25	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $338.84 / $870.96	Professional	TC	$257.04	$338.84	$870.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $851.14 / $1,230.27	Professional		$501.19	$851.14	$1,230.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $120.23 / $223.87	Professional	26	$85.11	$120.23	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $630.96 / $1,000.00	Professional	TC	$363.08	$630.96	$1,000.00
HMSA Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,621.81 / $1,778.28	Professional		$1,230.27	$1,621.81	$1,778.28
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $134.90 / $141.25	Professional	26	$131.83	$134.90	$141.25
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,258.93 / $1,258.93 / $1,318.26	Professional	TC	$1,258.93	$1,258.93	$1,318.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $446.68 / $524.81	Professional		$380.19	$446.68	$524.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $120.23 / $141.25	Professional	26	$104.71	$120.23	$141.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $323.59 / $380.19	Professional	TC	$281.84	$323.59	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $724.44 / $1,230.27	Professional		$407.38	$724.44	$1,230.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $134.90 / $218.78	Professional	26	$117.49	$134.90	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $562.34 / $1,096.48	Professional	TC	$288.40	$562.34	$1,096.48
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $794.33 / $1,513.56	Professional		$478.63	$794.33	$1,513.56
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $147.91 / $223.87	Professional	26	$109.65	$147.91	$223.87
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $676.08 / $1,380.38	Professional	TC	$354.81	$676.08	$1,380.38