Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.98 / $117.85 / $138.65	Facility	26	$103.98	$117.85	$138.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $357.53 / $494.18 / $609.30	Professional		$357.53	$494.18	$609.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.88 / $143.32 / $259.56	Professional	26	$97.88	$143.32	$259.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $368.50 / $450.68	Professional	TC	$335.00	$368.50	$450.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $487.39 / $855.89 / $1,109.34	Professional		$487.39	$855.89	$1,109.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.90 / $125.42 / $154.05	Professional	26	$104.90	$125.42	$154.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $341.43 / $752.49 / $983.94	Professional	TC	$341.43	$752.49	$983.94
HMSA Facility/Professional Professional Modifier Low / Median / High Price $130.69 / $1,391.95 / $1,793.21	Professional		$130.69	$1,391.95	$1,793.21
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $139.97 / $146.57 / $150.22	Professional	26	$139.97	$146.57	$150.22
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,251.98 / $1,310.97 / $1,311.32	Professional	TC	$1,251.98	$1,310.97	$1,311.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $405.47 / $442.33 / $516.04	Professional		$405.47	$442.33	$516.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.97 / $123.24 / $143.78	Professional	26	$112.97	$123.24	$143.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $292.50 / $319.08 / $337.71	Professional	TC	$292.50	$319.08	$337.71
United Facility/Professional Professional Modifier Low / Median / High Price $213.98 / $497.62 / $745.01	Professional		$213.98	$497.62	$745.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.21 / $138.65 / $173.12	Professional	26	$63.21	$138.65	$173.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.77 / $358.98 / $575.25	Professional	TC	$150.77	$358.98	$575.25
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $456.73 / $833.07 / $1,551.55	Professional		$456.73	$833.07	$1,551.55
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $106.26 / $154.94 / $264.87	Professional	26	$106.26	$154.94	$264.87
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $329.73 / $710.46 / $1,396.61	Professional	TC	$329.73	$710.46	$1,396.61