Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $165.96 / $371.54	Professional		$131.83	$165.96	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $51.29 / $169.82	Professional	26	$42.66	$51.29	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $117.49 / $263.03	Professional	TC	$89.13	$117.49	$263.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $204.17 / $316.23	Professional		$125.89	$204.17	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $52.48 / $97.72	Professional	26	$40.74	$52.48	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $131.83 / $218.78	Professional	TC	$83.18	$131.83	$218.78
HMSA Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $239.88 / $269.15	Professional		$154.88	$239.88	$269.15
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $75.86 / $77.62	Professional	26	$72.44	$75.86	$77.62
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $181.97 / $181.97	Professional	TC	$173.78	$181.97	$181.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $181.97 / $213.80	Professional		$165.96	$181.97	$213.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $53.70 / $61.66	Professional	26	$48.98	$53.70	$61.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $128.82 / $151.36	Professional	TC	$117.49	$128.82	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $177.83 / $251.19	Professional		$131.83	$177.83	$251.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $53.70 / $69.18	Professional	26	$38.02	$53.70	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $120.23 / $186.21	Professional	TC	$91.20	$120.23	$186.21
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $190.55 / $323.59	Professional		$123.03	$190.55	$323.59
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $54.95 / $95.50	Professional	26	$38.90	$54.95	$95.50
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $131.83 / $229.09	Professional	TC	$83.18	$131.83	$229.09