Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $111.48 / $126.34 / $148.63	Facility	26	$111.48	$126.34	$148.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $414.14 / $496.27 / $515.60	Professional		$414.14	$496.27	$515.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.37 / $116.10 / $169.76	Professional	26	$104.37	$116.10	$169.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $309.76 / $345.83 / $385.70	Professional	TC	$309.76	$345.83	$385.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $422.44 / $603.87 / $757.35	Professional		$422.44	$603.87	$757.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $119.43 / $133.44 / $164.17	Professional	26	$119.43	$133.44	$164.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $275.44 / $484.53 / $623.91	Professional	TC	$275.44	$484.53	$623.91
HMSA Facility/Professional Professional Modifier Low / Median / High Price $135.91 / $943.20 / $1,137.54	Professional		$135.91	$943.20	$1,137.54
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $148.99 / $156.01 / $159.91	Professional	26	$148.99	$156.01	$159.91
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $794.21 / $831.63 / $831.69	Professional	TC	$794.21	$831.63	$831.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $345.54 / $376.96 / $439.78	Professional		$345.54	$376.96	$439.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $121.11 / $132.12 / $154.13	Professional	26	$121.11	$132.12	$154.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $224.43 / $244.84 / $259.12	Professional	TC	$224.43	$244.84	$259.12
United Facility/Professional Professional Modifier Low / Median / High Price $253.13 / $560.48 / $751.79	Professional		$253.13	$560.48	$751.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.34 / $148.63 / $186.56	Professional	26	$71.34	$148.63	$186.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.78 / $395.83 / $565.23	Professional	TC	$181.78	$395.83	$565.23
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $389.14 / $613.10 / $1,054.90	Professional		$389.14	$613.10	$1,054.90
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $113.72 / $165.83 / $284.79	Professional	26	$113.72	$165.83	$284.79
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $253.00 / $478.91 / $889.07	Professional	TC	$253.00	$478.91	$889.07