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 / $475.00 / $697.67	Professional		$250.00	$475.00	$697.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $140.00 / $142.13 / $155.58	Professional	26	$140.00	$142.13	$155.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $348.53 / $542.08	Professional	TC	$335.00	$348.53	$542.08
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 $533.94 / $826.16 / $1,101.48	Professional		$533.94	$826.16	$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 $416.97 / $710.96 / $981.80	Professional	TC	$416.97	$710.96	$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 $462.56 / $504.61 / $588.71	Professional		$462.56	$504.61	$588.71
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 $351.78 / $383.76 / $406.15	Professional	TC	$351.78	$383.76	$406.15
United Facility/Professional Professional Modifier Low / Median / High Price $246.10 / $692.21 / $767.48	Professional		$246.10	$692.21	$767.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.60 / $131.65 / $181.14	Professional	26	$86.60	$131.65	$181.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $184.11 / $431.73 / $597.71	Professional	TC	$184.11	$431.73	$597.71
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $521.10 / $823.76 / $1,522.21	Professional		$521.10	$823.76	$1,522.21
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 $396.55 / $664.34 / $1,393.60	Professional	TC	$396.55	$664.34	$1,393.60