Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.88 / $96.19 / $113.17	Facility	26	$84.88	$96.19	$113.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $475.00 / $494.18 / $631.59	Professional		$475.00	$494.18	$631.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.89 / $140.00 / $235.75	Professional	26	$90.89	$140.00	$235.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $348.53 / $501.95	Professional	TC	$335.00	$348.53	$501.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.25 / $97.25 / $97.25	Facility	26	$97.25	$97.25	$97.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $483.43 / $876.87 / $1,115.34	Professional		$483.43	$876.87	$1,115.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.14 / $99.92 / $123.73	Professional	26	$92.14	$99.92	$123.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $363.01 / $794.16 / $991.62	Professional	TC	$363.01	$794.16	$991.62
HMSA Facility/Professional Professional Modifier Low / Median / High Price $102.56 / $1,232.55 / $1,604.35	Professional		$102.56	$1,232.55	$1,604.35
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $112.42 / $117.72 / $120.66	Professional	26	$112.42	$117.72	$120.66
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,120.13 / $1,172.91 / $1,172.91	Professional	TC	$1,120.13	$1,172.91	$1,172.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $418.03 / $456.04 / $532.04	Professional		$418.03	$456.04	$532.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $92.21 / $100.60 / $117.36	Professional	26	$92.21	$100.60	$117.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $325.82 / $355.44 / $376.17	Professional	TC	$325.82	$355.44	$376.17
United Facility/Professional Professional Modifier Low / Median / High Price $212.54 / $513.04 / $885.43	Professional		$212.54	$513.04	$885.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.21 / $113.17 / $142.65	Professional	26	$52.21	$113.17	$142.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $160.33 / $399.87 / $765.85	Professional	TC	$160.33	$399.87	$765.85
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $470.95 / $986.79 / $1,479.60	Professional		$470.95	$986.79	$1,479.60
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $84.77 / $126.95 / $216.89	Professional	26	$84.77	$126.95	$216.89
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $367.29 / $871.20 / $1,346.58	Professional	TC	$367.29	$871.20	$1,346.58