Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.24 / $267.33 / $1,039.00	Professional		$229.24	$267.33	$1,039.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.30 / $102.86 / $389.45	Professional	26	$77.30	$102.86	$389.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $148.83 / $177.79 / $216.62	Professional	TC	$148.83	$177.79	$216.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $156.35 / $243.90 / $590.98	Professional		$156.35	$243.90	$590.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.72 / $84.10 / $152.75	Professional	26	$64.72	$84.10	$152.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.95 / $159.80 / $438.23	Professional	TC	$78.95	$159.80	$438.23
HMSA Facility/Professional Professional Modifier Low / Median / High Price $110.27 / $339.09 / $375.10	Professional		$110.27	$339.09	$375.10
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $114.16 / $119.54 / $122.52	Professional	26	$114.16	$119.54	$122.52
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $243.22 / $254.68 / $254.68	Professional	TC	$243.22	$254.68	$254.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $214.63 / $234.14 / $273.17	Professional		$214.63	$234.14	$273.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.01 / $80.73 / $94.19	Professional	26	$74.01	$80.73	$94.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $140.62 / $153.41 / $178.98	Professional	TC	$140.62	$153.41	$178.98
United Facility/Professional Professional Modifier Low / Median / High Price $175.61 / $243.90 / $319.14	Professional		$175.61	$243.90	$319.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.63 / $88.08 / $112.85	Professional	26	$68.63	$88.08	$112.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.06 / $159.80 / $206.30	Professional	TC	$115.06	$159.80	$206.30
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $150.11 / $248.75 / $669.44	Professional		$150.11	$248.75	$669.44
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $53.18 / $84.41 / $149.52	Professional	26	$53.18	$84.41	$149.52
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $84.37 / $164.35 / $318.56	Professional	TC	$84.37	$164.35	$318.56