Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $234.42 / $263.03 / $309.03	Facility	26	$234.42	$263.03	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $426.58 / $645.65	Professional		$316.23	$426.58	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $234.42 / $316.23	Professional	26	$162.18	$234.42	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $263.03 / $371.54	Professional	TC	$165.96	$263.03	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $524.81 / $1,096.48	Professional		$407.38	$524.81	$1,096.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $251.19 / $467.74	Professional	26	$173.78	$251.19	$467.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $269.15 / $616.60	Professional	TC	$239.88	$269.15	$616.60
HMSA Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $489.78 / $660.69	Professional		$407.38	$489.78	$660.69
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $288.40 / $302.00 / $309.03	Professional	26	$288.40	$302.00	$309.03
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $354.81 / $380.19	Professional	TC	$338.84	$354.81	$380.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $630.96 / $776.25	Professional		$537.03	$630.96	$776.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $281.84 / $331.13	Professional	26	$239.88	$281.84	$331.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $338.84 / $398.11	Professional	TC	$295.12	$338.84	$398.11
United Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $676.08 / $812.83	Professional		$389.05	$676.08	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $309.03 / $363.08	Professional	26	$165.96	$309.03	$363.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $354.81 / $457.09	Professional	TC	$223.87	$354.81	$457.09
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $741.31 / $1,318.26	Professional		$575.44	$741.31	$1,318.26
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $338.84 / $537.03	Professional	26	$229.09	$338.84	$537.03
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $407.38 / $724.44	Professional	TC	$331.13	$407.38	$724.44