Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.56 / $170.32 / $284.89	Professional		$133.56	$170.32	$284.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.18 / $47.85 / $98.30	Professional	26	$43.18	$47.85	$98.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.37 / $99.40 / $218.29	Professional	TC	$90.37	$99.40	$218.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.14 / $47.14 / $47.14	Facility	26	$47.14	$47.14	$47.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $124.79 / $157.43 / $214.29	Professional		$124.79	$157.43	$214.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.50 / $50.89 / $63.98	Professional	26	$43.50	$50.89	$63.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.81 / $107.59 / $160.97	Professional	TC	$73.81	$107.59	$160.97
HMSA Facility/Professional Professional Modifier Low / Median / High Price $51.55 / $145.57 / $210.23	Professional		$51.55	$145.57	$210.23
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $55.20 / $57.80 / $59.25	Professional	26	$55.20	$57.80	$59.25
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $152.43 / $152.43 / $152.43	Professional	TC	$152.43	$152.43	$152.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $188.57 / $205.72 / $240.00	Professional		$188.57	$205.72	$240.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.92 / $51.18 / $59.71	Professional	26	$46.92	$51.18	$59.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $141.66 / $154.54 / $180.29	Professional	TC	$141.66	$154.54	$180.29
United Facility/Professional Professional Modifier Low / Median / High Price $82.59 / $175.31 / $214.29	Professional		$82.59	$175.31	$214.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.52 / $54.08 / $80.00	Professional	26	$35.52	$54.08	$80.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.07 / $124.84 / $160.97	Professional	TC	$47.07	$124.84	$160.97
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $99.53 / $160.32 / $176.30	Professional		$99.53	$160.32	$176.30
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $31.25 / $47.77 / $55.35	Professional	26	$31.25	$47.77	$55.35
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $68.28 / $111.20 / $120.95	Professional	TC	$68.28	$111.20	$120.95