Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $156.83 / $177.74 / $209.10	Facility	26	$156.83	$177.74	$209.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $291.12 / $375.78 / $825.94	Professional		$291.12	$375.78	$825.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.97 / $144.66 / $242.46	Professional	26	$101.97	$144.66	$242.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $185.65 / $215.52 / $583.47	Professional	TC	$185.65	$215.52	$583.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $280.67 / $387.40 / $674.16	Professional		$280.67	$387.40	$674.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.37 / $169.74 / $209.10	Professional	26	$117.37	$169.74	$209.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $163.30 / $217.66 / $465.08	Professional	TC	$163.30	$217.66	$465.08
HMSA Facility/Professional Professional Modifier Low / Median / High Price $211.09 / $360.60 / $652.39	Professional		$211.09	$360.60	$652.39
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $195.80 / $205.03 / $242.63	Professional	26	$195.80	$205.03	$242.63
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $427.23 / $447.36 / $561.63	Professional	TC	$427.23	$447.36	$561.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $499.38 / $599.26 / $699.13	Professional		$499.38	$599.26	$699.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $159.54 / $185.87 / $216.85	Professional	26	$159.54	$185.87	$216.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $354.84 / $413.40 / $430.63	Professional	TC	$354.84	$413.40	$430.63
United Facility/Professional Professional Modifier Low / Median / High Price $486.30 / $674.16 / $689.72	Professional		$486.30	$674.16	$689.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $207.43 / $209.10 / $244.76	Professional	26	$207.43	$209.10	$244.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $278.87 / $444.96 / $465.08	Professional	TC	$278.87	$444.96	$465.08
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $597.75 / $734.81 / $971.30	Professional		$597.75	$734.81	$971.30
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $191.59 / $228.51 / $384.99	Professional	26	$191.59	$228.51	$384.99
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $385.63 / $506.42 / $586.30	Professional	TC	$385.63	$506.42	$586.30