Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $121.98 / $138.24 / $162.63	Facility	26	$121.98	$138.24	$162.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $475.00 / $522.50 / $646.92	Professional		$475.00	$522.50	$646.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $140.00 / $145.65 / $186.15	Professional	26	$140.00	$145.65	$186.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $348.53 / $460.76	Professional	TC	$335.00	$348.53	$460.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $469.80 / $651.37 / $762.72	Professional		$469.80	$651.37	$762.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $138.24 / $140.07 / $177.65	Professional	26	$138.24	$140.07	$177.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $341.96 / $526.79 / $601.71	Professional	TC	$341.96	$526.79	$601.71
HMSA Facility/Professional Professional Modifier Low / Median / High Price $147.57 / $966.38 / $1,152.46	Professional		$147.57	$966.38	$1,152.46
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $161.76 / $169.38 / $173.61	Professional	26	$161.76	$169.38	$173.61
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $804.62 / $842.53 / $842.53	Professional	TC	$804.62	$842.53	$842.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $431.56 / $470.80 / $549.26	Professional		$431.56	$470.80	$549.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $132.52 / $144.56 / $168.66	Professional	26	$132.52	$144.56	$168.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $299.05 / $326.23 / $345.26	Professional	TC	$299.05	$326.23	$345.26
United Facility/Professional Professional Modifier Low / Median / High Price $230.12 / $529.65 / $709.61	Professional		$230.12	$529.65	$709.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.64 / $162.63 / $201.71	Professional	26	$73.64	$162.63	$201.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $156.47 / $367.01 / $507.90	Professional	TC	$156.47	$367.01	$507.90
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $516.58 / $695.41 / $1,259.25	Professional		$516.58	$695.41	$1,259.25
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $140.19 / $189.55 / $307.95	Professional	26	$140.19	$189.55	$307.95
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $363.67 / $541.34 / $1,022.32	Professional	TC	$363.67	$541.34	$1,022.32