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 / $494.18 / $699.55	Professional		$250.00	$494.18	$699.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $140.00 / $145.65 / $284.77	Professional	26	$140.00	$145.65	$284.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $348.53 / $543.97	Professional	TC	$335.00	$348.53	$543.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.87 / $116.87 / $116.87	Facility	26	$116.87	$116.87	$116.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $533.36 / $826.16 / $1,101.48	Professional		$533.36	$826.16	$1,101.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $98.23 / $119.67 / $148.01	Professional	26	$98.23	$119.67	$148.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $417.84 / $711.51 / $981.80	Professional	TC	$417.84	$711.51	$981.80
HMSA Facility/Professional Professional Modifier Low / Median / High Price $121.64 / $1,383.16 / $1,790.11	Professional		$121.64	$1,383.16	$1,790.11
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $133.34 / $139.62 / $143.11	Professional	26	$133.34	$139.62	$143.11
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,249.82 / $1,308.71 / $1,309.20	Professional	TC	$1,249.82	$1,308.71	$1,309.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $463.79 / $505.96 / $590.28	Professional		$463.79	$505.96	$590.28
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 $353.01 / $385.10 / $407.57	Professional	TC	$353.01	$385.10	$407.57
United Facility/Professional Professional Modifier Low / Median / High Price $246.48 / $569.20 / $768.71	Professional		$246.48	$569.20	$768.71
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 $184.50 / $433.24 / $598.94	Professional	TC	$184.50	$433.24	$598.94
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $522.47 / $825.08 / $1,522.79	Professional		$522.47	$825.08	$1,522.79
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $101.63 / $152.10 / $259.26	Professional	26	$101.63	$152.10	$259.26
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $397.94 / $663.06 / $1,393.60	Professional	TC	$397.94	$663.06	$1,393.60