Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.91 / $193.82 / $1,445.85	Professional		$96.91	$193.82	$1,445.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.85 / $95.55 / $346.80	Professional	26	$31.85	$95.55	$346.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.13 / $56.98 / $215.97	Professional	TC	$48.13	$56.98	$215.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $130.65 / $130.65 / $130.65	Professional		$130.65	$130.65	$130.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.49 / $34.49 / $34.49	Professional	26	$34.49	$34.49	$34.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.16 / $96.16 / $96.16	Professional	TC	$96.16	$96.16	$96.16
HMSA Facility/Professional Professional Modifier Low / Median / High Price $53.87 / $150.75 / $188.00	Professional		$53.87	$150.75	$188.00
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $60.53 / $63.38 / $97.25	Professional	26	$60.53	$63.38	$97.25
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $85.12 / $89.13 / $90.73	Professional	TC	$85.12	$89.13	$90.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.97 / $125.42 / $146.33	Professional		$114.97	$125.42	$146.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.35 / $33.11 / $38.63	Professional	26	$30.35	$33.11	$38.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $84.62 / $92.32 / $107.70	Professional	TC	$84.62	$92.32	$107.70
United Facility/Professional Professional Modifier Low / Median / High Price $130.65 / $130.65 / $157.19	Professional		$130.65	$130.65	$157.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.49 / $34.49 / $46.34	Professional	26	$34.49	$34.49	$46.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.16 / $110.85 / $110.85	Professional	TC	$96.16	$110.85	$110.85
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $84.75 / $132.00 / $212.74	Professional		$84.75	$132.00	$212.74
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $25.07 / $38.14 / $63.56	Professional	26	$25.07	$38.14	$63.56
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $59.85 / $93.87 / $149.18	Professional	TC	$59.85	$93.87	$149.18