Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.91 / $48.63 / $57.21	Facility	26	$42.91	$48.63	$57.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $148.65 / $148.65 / $148.65	Professional		$148.65	$148.65	$148.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $118.84 / $118.84 / $118.84	Professional	TC	$118.84	$118.84	$118.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $259.86 / $259.86 / $366.41	Professional		$259.86	$259.86	$366.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.76 / $208.76 / $302.89	Professional	TC	$208.76	$208.76	$302.89
HMSA Facility/Professional Professional Modifier Low / Median / High Price $55.27 / $338.71 / $379.30	Professional		$55.27	$338.71	$379.30
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $264.82 / $277.30 / $277.30	Professional	TC	$264.82	$277.30	$277.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $243.65 / $265.80 / $276.88	Professional		$243.65	$265.80	$276.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.62 / $50.86 / $52.98	Professional	26	$46.62	$50.86	$52.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $197.03 / $214.94 / $223.90	Professional	TC	$197.03	$214.94	$223.90
United Facility/Professional Professional Modifier Low / Median / High Price $299.02 / $346.86 / $386.70	Professional		$299.02	$346.86	$386.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $241.81 / $286.74 / $315.12	Professional	TC	$241.81	$286.74	$315.12
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $274.51 / $357.61 / $620.76	Professional		$274.51	$357.61	$620.76
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $222.11 / $290.35 / $504.50	Professional	TC	$222.11	$290.35	$504.50