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 $398.81 / $497.42 / $572.28	Professional		$398.81	$497.42	$572.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.45 / $140.00 / $303.13	Professional	26	$109.45	$140.00	$303.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $348.53 / $406.56	Professional	TC	$335.00	$348.53	$406.56
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 $429.65 / $844.29 / $1,125.74	Professional		$429.65	$844.29	$1,125.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.51 / $131.38 / $160.91	Professional	26	$120.51	$131.38	$160.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $304.10 / $677.27 / $994.34	Professional	TC	$304.10	$677.27	$994.34
HMSA Facility/Professional Professional Modifier Low / Median / High Price $134.49 / $1,411.49 / $1,810.54	Professional		$134.49	$1,411.49	$1,810.54
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $147.41 / $154.36 / $158.22	Professional	26	$147.41	$154.36	$158.22
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,264.08 / $1,323.64 / $1,324.22	Professional	TC	$1,264.08	$1,323.64	$1,324.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $381.89 / $416.60 / $486.04	Professional		$381.89	$416.60	$486.04
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 $263.88 / $287.87 / $304.66	Professional	TC	$263.88	$287.87	$304.66
United Facility/Professional Professional Modifier Low / Median / High Price $86.60 / $447.37 / $619.12	Professional		$86.60	$447.37	$619.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.00 / $144.83 / $181.19	Professional	26	$80.00	$144.83	$181.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.94 / $323.85 / $437.93	Professional	TC	$134.94	$323.85	$437.93
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $430.13 / $857.34 / $1,607.51	Professional		$430.13	$857.34	$1,607.51
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $112.23 / $168.00 / $276.12	Professional	26	$112.23	$168.00	$276.12
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $297.45 / $665.61 / $1,436.23	Professional	TC	$297.45	$665.61	$1,436.23