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 $141.96 / $494.18 / $608.16	Professional		$141.96	$494.18	$608.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $133.25 / $145.65 / $155.58	Professional	26	$133.25	$145.65	$155.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $293.89 / $348.53 / $452.58	Professional	TC	$293.89	$348.53	$452.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $485.82 / $850.13 / $1,101.08	Professional		$485.82	$850.13	$1,101.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $98.23 / $119.29 / $147.46	Professional	26	$98.23	$119.29	$147.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $343.16 / $751.90 / $981.80	Professional	TC	$343.16	$751.90	$981.80
HMSA Facility/Professional Professional Modifier Low / Median / High Price $121.52 / $1,383.02 / $1,790.11	Professional		$121.52	$1,383.02	$1,790.11
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $133.19 / $139.47 / $142.96	Professional	26	$133.19	$139.47	$142.96
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 $404.51 / $441.29 / $514.84	Professional		$404.51	$441.29	$514.84
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 $293.73 / $320.44 / $339.13	Professional	TC	$293.73	$320.44	$339.13
United Facility/Professional Professional Modifier Low / Median / High Price $213.32 / $496.45 / $739.25	Professional		$213.32	$496.45	$739.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.79 / $135.96 / $169.16	Professional	26	$61.79	$135.96	$169.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.53 / $360.49 / $577.87	Professional	TC	$151.53	$360.49	$577.87
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $455.65 / $831.14 / $1,541.69	Professional		$455.65	$831.14	$1,541.69
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $101.26 / $151.54 / $258.31	Professional	26	$101.26	$151.54	$258.31
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $331.12 / $714.30 / $1,394.44	Professional	TC	$331.12	$714.30	$1,394.44