Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.25 / $122.68 / $144.33	Facility	26	$108.25	$122.68	$144.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $247.93 / $494.18 / $831.76	Professional		$247.93	$494.18	$831.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.76 / $153.02 / $372.43	Professional	26	$110.76	$153.02	$372.43
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $125.00 / $125.00	Professional	52	$125.00	$125.00	$125.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $323.85 / $335.00 / $406.56	Professional	TC	$323.85	$335.00	$406.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $123.88	Facility	26	$123.88	$123.88	$123.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $428.59 / $850.79 / $1,125.74	Professional		$428.59	$850.79	$1,125.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.89 / $131.38 / $160.37	Professional	26	$120.89	$131.38	$160.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $303.01 / $674.51 / $994.34	Professional	TC	$303.01	$674.51	$994.34
HMSA Facility/Professional Professional Modifier Low / Median / High Price $134.22 / $1,411.20 / $1,810.54	Professional		$134.22	$1,411.20	$1,810.54
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $147.12 / $154.05 / $157.91	Professional	26	$147.12	$154.05	$157.91
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,264.08 / $1,323.64 / $1,324.23	Professional	TC	$1,264.08	$1,323.64	$1,324.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $381.48 / $416.16 / $485.52	Professional		$381.48	$416.16	$485.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $117.60 / $128.29 / $149.66	Professional	26	$117.60	$128.29	$149.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $263.88 / $287.87 / $304.66	Professional	TC	$263.88	$287.87	$304.66
United Facility/Professional Professional Modifier Low / Median / High Price $200.10 / $468.18 / $615.40	Professional		$200.10	$468.18	$615.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.29 / $144.33 / $181.19	Professional	26	$66.29	$144.33	$181.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $133.81 / $323.85 / $434.21	Professional	TC	$133.81	$323.85	$434.21
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $429.67 / $854.04 / $1,607.51	Professional		$429.67	$854.04	$1,607.51
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $105.83 / $167.58 / $275.17	Professional	26	$105.83	$167.58	$275.17
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $297.45 / $681.42 / $1,436.23	Professional	TC	$297.45	$681.42	$1,436.23