Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.74 / $108.51 / $127.66	Facility	26	$95.74	$108.51	$127.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $620.95 / $1,099.28 / $1,475.10	Professional		$620.95	$1,099.28	$1,475.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.09 / $103.27 / $511.74	Professional	26	$67.09	$103.27	$511.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $553.86 / $996.01 / $1,329.36	Professional	TC	$553.86	$996.01	$1,329.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,025.58 / $1,025.58 / $1,423.79	Professional		$1,025.58	$1,025.58	$1,423.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.39 / $117.39 / $140.69	Professional	26	$117.39	$117.39	$140.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $908.19 / $908.19 / $1,283.09	Professional	TC	$908.19	$908.19	$1,283.09
HMSA Facility/Professional Professional Modifier Low / Median / High Price $120.98 / $157.44 / $1,323.84	Professional		$120.98	$157.44	$1,323.84
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $125.96 / $131.90 / $135.19	Professional	26	$125.96	$131.90	$135.19
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,138.30 / $1,191.94 / $1,191.94	Professional	TC	$1,138.30	$1,191.94	$1,191.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $966.99 / $1,054.90 / $1,098.84	Professional		$966.99	$1,054.90	$1,098.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.02 / $113.47 / $118.20	Professional	26	$104.02	$113.47	$118.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $862.97 / $941.42 / $980.65	Professional	TC	$862.97	$941.42	$980.65
United Facility/Professional Professional Modifier Low / Median / High Price $1,186.76 / $1,304.66 / $1,619.20	Professional		$1,186.76	$1,304.66	$1,619.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $127.66 / $142.88 / $161.33	Professional	26	$127.66	$142.88	$161.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $600.94 / $1,059.09 / $1,457.87	Professional	TC	$600.94	$1,059.09	$1,457.87
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $1,089.72 / $1,391.44 / $1,636.37	Professional		$1,089.72	$1,391.44	$1,636.37
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $116.91 / $139.82 / $164.72	Professional	26	$116.91	$139.82	$164.72
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $972.80 / $1,248.33 / $1,471.67	Professional	TC	$972.80	$1,248.33	$1,471.67