Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $135.01 / $135.01 / $135.01	Facility		$135.01	$135.01	$135.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.43 / $150.79 / $790.00	Professional		$127.43	$150.79	$790.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.48 / $22.88 / $93.20	Professional	26	$20.48	$22.88	$93.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $106.95 / $117.11 / $206.11	Professional	TC	$106.95	$117.11	$206.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.30 / $147.30 / $147.30	Facility		$147.30	$147.30	$147.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.35 / $26.35 / $26.35	Facility	26	$26.35	$26.35	$26.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.63 / $179.63 / $386.30	Professional		$129.63	$179.63	$386.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.43 / $26.91 / $50.12	Professional	26	$21.43	$26.91	$50.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $108.21 / $153.22 / $336.18	Professional	TC	$108.21	$153.22	$336.18
HMSA Facility/Professional Professional Modifier Low / Median / High Price $23.06 / $193.30 / $231.83	Professional		$23.06	$193.30	$231.83
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $24.70 / $25.86 / $26.51	Professional	26	$24.70	$25.86	$26.51
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $168.60 / $176.54 / $206.67	Professional	TC	$168.60	$176.54	$206.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $157.78 / $172.13 / $200.82	Professional		$157.78	$172.13	$200.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.90 / $26.08 / $30.42	Professional	26	$23.90	$26.08	$30.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $133.88 / $146.05 / $170.39	Professional	TC	$133.88	$146.05	$170.39
United Facility/Professional Professional Modifier Low / Median / High Price $135.79 / $179.30 / $256.95	Professional		$135.79	$179.30	$256.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.99 / $27.16 / $37.65	Professional	26	$20.99	$27.16	$37.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.28 / $152.13 / $219.30	Professional	TC	$112.28	$152.13	$219.30
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $128.21 / $171.95 / $369.52	Professional		$128.21	$171.95	$369.52
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $20.22 / $24.11 / $57.27	Professional	26	$20.22	$24.11	$57.27
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $107.98 / $144.83 / $312.25	Professional	TC	$107.98	$144.83	$312.25