Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.62 / $123.10 / $144.83	Facility	26	$108.62	$123.10	$144.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.46 / $494.18 / $574.79	Professional		$400.46	$494.18	$574.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.45 / $140.00 / $222.45	Professional	26	$109.45	$140.00	$222.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $348.53 / $409.09	Professional	TC	$335.00	$348.53	$409.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $432.14 / $826.99 / $1,136.80	Professional		$432.14	$826.99	$1,136.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.10 / $142.46 / $160.91	Professional	26	$123.10	$142.46	$160.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $306.58 / $652.11 / $994.34	Professional	TC	$306.58	$652.11	$994.34
HMSA Facility/Professional Professional Modifier Low / Median / High Price $146.04 / $1,424.16 / $1,810.54	Professional		$146.04	$1,424.16	$1,810.54
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $160.08 / $167.62 / $171.81	Professional	26	$160.08	$167.62	$171.81
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,264.08 / $1,323.64 / $1,324.67	Professional	TC	$1,264.08	$1,323.64	$1,324.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $383.53 / $418.39 / $488.12	Professional		$383.53	$418.39	$488.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $118.01 / $128.74 / $150.19	Professional	26	$118.01	$128.74	$150.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $265.52 / $289.66 / $306.55	Professional	TC	$265.52	$289.66	$306.55
United Facility/Professional Professional Modifier Low / Median / High Price $202.00 / $470.69 / $621.59	Professional		$202.00	$470.69	$621.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.29 / $144.83 / $181.19	Professional	26	$66.29	$144.83	$181.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $135.71 / $325.86 / $440.40	Professional	TC	$135.71	$325.86	$440.40
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $431.98 / $860.64 / $1,621.69	Professional		$431.98	$860.64	$1,621.69
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $121.55 / $177.56 / $275.17	Professional	26	$121.55	$177.56	$275.17
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $299.31 / $621.36 / $1,436.23	Professional	TC	$299.31	$621.36	$1,436.23