Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $225.20 / $310.63 / $515.75	Professional		$225.20	$310.63	$515.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.84 / $99.81 / $477.70	Professional	26	$79.84	$99.81	$477.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $153.21 / $153.21 / $391.01	Professional	TC	$153.21	$153.21	$391.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $388.29 / $388.29 / $388.29	Professional		$388.29	$388.29	$388.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.81 / $99.81 / $99.81	Professional	26	$99.81	$99.81	$99.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $288.48 / $288.48 / $288.48	Professional	TC	$288.48	$288.48	$288.48
HMSA Facility/Professional Professional Modifier Low / Median / High Price $100.85 / $415.04 / $434.60	Professional		$100.85	$415.04	$434.60
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $113.31 / $118.65 / $169.98	Professional	26	$113.31	$118.65	$169.98
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $252.04 / $263.92 / $340.32	Professional	TC	$252.04	$263.92	$340.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $341.69 / $372.76 / $434.88	Professional		$341.69	$372.76	$434.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.84 / $95.82 / $111.79	Professional	26	$87.84	$95.82	$111.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $253.86 / $276.94 / $323.08	Professional	TC	$253.86	$276.94	$323.08
United Facility/Professional Professional Modifier Low / Median / High Price $388.29 / $388.29 / $469.55	Professional		$388.29	$388.29	$469.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.81 / $99.81 / $135.94	Professional	26	$99.81	$99.81	$135.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $288.48 / $288.48 / $333.60	Professional	TC	$288.48	$288.48	$333.60
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $183.28 / $362.49 / $524.95	Professional		$183.28	$362.49	$524.95
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $77.43 / $116.42 / $160.30	Professional	26	$77.43	$116.42	$160.30
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $86.03 / $232.11 / $364.65	Professional	TC	$86.03	$232.11	$364.65