Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $954.99 / $4,168.69	Professional		$741.31	$954.99	$4,168.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $181.97 / $1,000.00	Professional	26	$114.82	$181.97	$1,000.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $741.31 / $1,047.13	Professional	TC	$616.60	$741.31	$1,047.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $1,174.90 / $1,949.84	Professional		$851.14	$1,174.90	$1,949.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $213.80 / $331.13	Professional	26	$138.04	$213.80	$331.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $933.25 / $1,659.59	Professional	TC	$691.83	$933.25	$1,659.59
HMSA Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,288.25 / $4,570.88	Professional		$933.25	$1,288.25	$4,570.88
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $234.42 / $245.47	Professional	26	$229.09	$234.42	$245.47
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $1,000.00 / $1,047.13 / $1,047.13	Professional	TC	$1,000.00	$1,047.13	$1,047.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,071.52 / $1,258.93	Professional		$1,000.00	$1,071.52	$1,258.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $147.91 / $169.82	Professional	26	$134.90	$147.91	$169.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $851.14 / $933.25 / $1,096.48	Professional	TC	$851.14	$933.25	$1,096.48
United Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $954.99 / $1,288.25	Professional		$724.44	$954.99	$1,288.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $151.36 / $269.15	Professional	26	$109.65	$151.36	$269.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $812.83 / $1,023.29	Professional	TC	$616.60	$812.83	$1,023.29
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $1,047.13 / $1,698.24	Professional		$630.96	$1,047.13	$1,698.24
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $138.04 / $194.98	Professional	26	$83.18	$138.04	$194.98
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $851.14 / $977.24	Professional	TC	$549.54	$851.14	$977.24