Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.97 / $115.56 / $135.96	Facility	26	$101.97	$115.56	$135.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $522.50 / $745.15	Professional		$250.00	$522.50	$745.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.87 / $144.09 / $155.58	Professional	26	$131.87	$144.09	$155.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $348.53 / $589.57	Professional	TC	$335.00	$348.53	$589.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.52 / $116.52 / $116.52	Facility	26	$116.52	$116.52	$116.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $565.04 / $851.50 / $1,101.48	Professional		$565.04	$851.50	$1,101.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $98.57 / $119.67 / $148.01	Professional	26	$98.57	$119.67	$148.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $450.63 / $752.93 / $981.80	Professional	TC	$450.63	$752.93	$981.80
HMSA Facility/Professional Professional Modifier Low / Median / High Price $122.00 / $1,383.55 / $1,790.11	Professional		$122.00	$1,383.55	$1,790.11
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $133.72 / $140.03 / $143.53	Professional	26	$133.72	$140.03	$143.53
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,249.82 / $1,308.71 / $1,308.83	Professional	TC	$1,249.82	$1,308.71	$1,308.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $493.43 / $538.28 / $628.00	Professional		$493.43	$538.28	$628.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $110.78 / $120.85 / $140.99	Professional	26	$110.78	$120.85	$140.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $382.65 / $417.43 / $441.78	Professional	TC	$382.65	$417.43	$441.78
United Facility/Professional Professional Modifier Low / Median / High Price $260.98 / $605.57 / $815.51	Professional		$260.98	$605.57	$815.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.98 / $135.96 / $169.77	Professional	26	$61.98	$135.96	$169.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $377.16 / $585.54 / $645.74	Professional	TC	$377.16	$585.54	$645.74
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $555.88 / $875.31 / $1,542.87	Professional		$555.88	$875.31	$1,542.87
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $101.63 / $151.54 / $259.26	Professional	26	$101.63	$151.54	$259.26
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $431.35 / $709.61 / $1,395.04	Professional	TC	$431.35	$709.61	$1,395.04