Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $108.65 / $174.57 / $654.57	Professional		$108.65	$174.57	$654.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.87 / $28.99 / $139.76	Professional	26	$25.87	$28.99	$139.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.57 / $93.84 / $137.19	Professional	TC	$86.57	$93.84	$137.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.20 / $28.20 / $28.20	Facility	26	$28.20	$28.20	$28.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.65 / $131.51 / $310.92	Professional		$89.65	$131.51	$310.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.37 / $30.25 / $55.03	Professional	26	$23.37	$30.25	$55.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.28 / $101.26 / $255.89	Professional	TC	$66.28	$101.26	$255.89
HMSA Facility/Professional Professional Modifier Low / Median / High Price $38.81 / $184.92 / $291.14	Professional		$38.81	$184.92	$291.14
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $41.18 / $43.12 / $44.20	Professional	26	$41.18	$43.12	$44.20
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $142.71 / $149.43 / $149.43	Professional	TC	$142.71	$149.43	$149.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $115.73 / $126.25 / $147.29	Professional		$115.73	$126.25	$147.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.62 / $29.04 / $33.88	Professional	26	$26.62	$29.04	$33.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.11 / $97.21 / $113.41	Professional	TC	$89.11	$97.21	$113.41
United Facility/Professional Professional Modifier Low / Median / High Price $106.95 / $147.81 / $168.02	Professional		$106.95	$147.81	$168.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.71 / $30.25 / $40.71	Professional	26	$19.71	$30.25	$40.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.53 / $101.26 / $127.31	Professional	TC	$77.53	$101.26	$127.31
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $94.49 / $130.37 / $349.98	Professional		$94.49	$130.37	$349.98
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $22.19 / $30.29 / $53.94	Professional	26	$22.19	$30.29	$53.94
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $72.25 / $99.47 / $186.92	Professional	TC	$72.25	$99.47	$186.92