Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.76 / $107.39 / $126.35	Facility	26	$94.76	$107.39	$126.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $388.85 / $477.43 / $552.44	Professional		$388.85	$477.43	$552.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.53 / $118.21 / $205.70	Professional	26	$84.53	$118.21	$205.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $304.31 / $373.53 / $468.96	Professional	TC	$304.31	$373.53	$468.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.46 / $108.46 / $108.46	Facility	26	$108.46	$108.46	$108.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $401.27 / $493.30 / $600.64	Professional		$401.27	$493.30	$600.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.48 / $116.30 / $138.66	Professional	26	$104.48	$116.30	$138.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $302.83 / $373.53 / $472.03	Professional	TC	$302.83	$373.53	$472.03
HMSA Facility/Professional Professional Modifier Low / Median / High Price $152.03 / $1,024.13 / $1,233.65	Professional		$152.03	$1,024.13	$1,233.65
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $162.82 / $170.49 / $174.75	Professional	26	$162.82	$170.49	$174.75
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $861.31 / $901.89 / $902.19	Professional	TC	$861.31	$901.89	$902.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $407.31 / $444.34 / $518.39	Professional		$407.31	$444.34	$518.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.95 / $112.31 / $131.03	Professional	26	$102.95	$112.31	$131.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $304.36 / $332.03 / $351.40	Professional	TC	$304.36	$332.03	$351.40
United Facility/Professional Professional Modifier Low / Median / High Price $209.78 / $499.88 / $622.98	Professional		$209.78	$499.88	$622.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.43 / $126.35 / $158.43	Professional	26	$60.43	$126.35	$158.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $149.35 / $373.53 / $464.55	Professional	TC	$149.35	$373.53	$464.55
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $482.29 / $610.59 / $977.94	Professional		$482.29	$610.59	$977.94
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $105.66 / $145.77 / $241.45	Professional	26	$105.66	$145.77	$241.45
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $367.42 / $462.36 / $756.03	Professional	TC	$367.42	$462.36	$756.03