Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.40 / $127.38 / $149.86	Facility		$112.40	$127.38	$149.86
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.51 / $17.57 / $20.68	Facility	26	$15.51	$17.57	$20.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.59 / $98.50 / $185.93	Professional		$81.59	$98.50	$185.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.19 / $15.81 / $81.76	Professional	26	$14.19	$15.81	$81.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.40 / $82.69 / $162.19	Professional	TC	$67.40	$82.69	$162.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $116.32 / $116.32 / $116.32	Facility		$116.32	$116.32	$116.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.75 / $17.75 / $17.75	Facility	26	$17.75	$17.75	$17.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.13 / $101.21 / $149.86	Professional		$82.13	$101.21	$149.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.57 / $19.11 / $22.45	Professional	26	$17.57	$19.11	$22.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.59 / $80.81 / $129.19	Professional	TC	$63.59	$80.81	$129.19
HMSA Facility/Professional Professional Modifier Low / Median / High Price $19.23 / $126.44 / $159.84	Professional		$19.23	$126.44	$159.84
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $20.59 / $21.56 / $22.10	Professional	26	$20.59	$21.56	$22.10
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $131.54 / $137.74 / $137.74	Professional	TC	$131.54	$137.74	$137.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $122.11 / $133.21 / $155.41	Professional		$122.11	$133.21	$155.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.85 / $18.38 / $21.45	Professional	26	$16.85	$18.38	$21.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $105.27 / $114.84 / $121.54	Professional	TC	$105.27	$114.84	$121.54
United Facility/Professional Professional Modifier Low / Median / High Price $52.85 / $149.86 / $166.69	Professional		$52.85	$149.86	$166.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.38 / $20.68 / $25.76	Professional	26	$9.38	$20.68	$25.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.47 / $129.19 / $140.93	Professional	TC	$43.47	$129.19	$140.93
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $96.16 / $163.13 / $215.81	Professional		$96.16	$163.13	$215.81
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $15.63 / $23.37 / $34.56	Professional	26	$15.63	$23.37	$34.56
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $80.54 / $132.80 / $176.04	Professional	TC	$80.54	$132.80	$176.04