Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.89 / $121.14 / $142.52	Facility	26	$106.89	$121.14	$142.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $475.00 / $494.18 / $857.21	Professional		$475.00	$494.18	$857.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $140.00 / $147.86 / $162.99	Professional	26	$140.00	$147.86	$162.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $348.53 / $694.20	Professional	TC	$335.00	$348.53	$694.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.33 / $122.33 / $122.33	Facility	26	$122.33	$122.33	$122.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $646.70 / $913.37 / $1,102.95	Professional		$646.70	$913.37	$1,102.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.23 / $125.42 / $154.83	Professional	26	$104.23	$125.42	$154.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $535.24 / $809.62 / $977.53	Professional	TC	$535.24	$809.62	$977.53
HMSA Facility/Professional Professional Modifier Low / Median / High Price $127.70 / $1,384.61 / $1,782.69	Professional		$127.70	$1,384.61	$1,782.69
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $139.97 / $146.57 / $150.22	Professional	26	$139.97	$146.57	$150.22
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,244.64 / $1,303.29 / $1,303.29	Professional	TC	$1,244.64	$1,303.29	$1,303.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $566.63 / $618.14 / $721.17	Professional		$566.63	$618.14	$721.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $116.13 / $126.68 / $147.80	Professional	26	$116.13	$126.68	$147.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $450.51 / $491.46 / $520.13	Professional	TC	$450.51	$491.46	$520.13
United Facility/Professional Professional Modifier Low / Median / High Price $301.19 / $695.41 / $1,323.89	Professional		$301.19	$695.41	$1,323.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.84 / $142.52 / $177.62	Professional	26	$64.84	$142.52	$177.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $236.35 / $552.89 / $767.12	Professional	TC	$236.35	$552.89	$767.12
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $638.39 / $947.96 / $1,591.13	Professional		$638.39	$947.96	$1,591.13
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $106.64 / $158.88 / $271.72	Professional	26	$106.64	$158.88	$271.72
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $507.84 / $824.91 / $1,436.19	Professional	TC	$507.84	$824.91	$1,436.19