Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.98 / $117.85 / $138.65	Facility	26	$103.98	$117.85	$138.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $475.00 / $522.50 / $606.79	Professional		$475.00	$522.50	$606.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.00 / $143.32 / $158.62	Professional	26	$106.00	$143.32	$158.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $289.38 / $335.00 / $448.16	Professional	TC	$289.38	$335.00	$448.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $486.53 / $855.55 / $1,109.34	Professional		$486.53	$855.55	$1,109.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.90 / $125.42 / $154.05	Professional	26	$104.90	$125.42	$154.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $340.57 / $752.15 / $983.94	Professional	TC	$340.57	$752.15	$983.94
HMSA Facility/Professional Professional Modifier Low / Median / High Price $127.70 / $1,391.95 / $1,793.21	Professional		$127.70	$1,391.95	$1,793.21
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 $1,251.98 / $1,310.97 / $1,311.32	Professional	TC	$1,251.98	$1,310.97	$1,311.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $403.84 / $440.56 / $513.98	Professional		$403.84	$440.56	$513.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.97 / $123.24 / $143.78	Professional	26	$112.97	$123.24	$143.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $290.86 / $317.30 / $335.81	Professional	TC	$290.86	$317.30	$335.81
United Facility/Professional Professional Modifier Low / Median / High Price $213.60 / $495.63 / $743.96	Professional		$213.60	$495.63	$743.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.21 / $138.65 / $173.12	Professional	26	$63.21	$138.65	$173.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.38 / $356.97 / $574.20	Professional	TC	$150.38	$356.97	$574.20
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $454.88 / $967.20 / $1,672.85	Professional		$454.88	$967.20	$1,672.85
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $106.26 / $154.94 / $264.87	Professional	26	$106.26	$154.94	$264.87
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $327.88 / $736.88 / $1,506.97	Professional	TC	$327.88	$736.88	$1,506.97