Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $954.99 / $954.99 / $954.99	Facility		$954.99	$954.99	$954.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $204.17 / $446.68	Professional		$169.82	$204.17	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $44.67 / $144.54	Professional	26	$33.88	$44.67	$144.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $173.78 / $281.84	Professional	TC	$138.04	$173.78	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $239.88 / $478.63	Professional		$162.18	$239.88	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $39.81 / $83.18	Professional	26	$34.67	$39.81	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $194.98 / $398.11	Professional	TC	$128.82	$194.98	$398.11
HMSA Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $234.42 / $263.03	Professional		$181.97	$234.42	$263.03
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $43.65 / $44.67	Professional	26	$41.69	$43.65	$44.67
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $190.55 / $223.87	Professional	TC	$181.97	$190.55	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $239.88 / $275.42	Professional		$218.78	$239.88	$275.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $44.67 / $51.29	Professional	26	$40.74	$44.67	$51.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $194.98 / $229.09	Professional	TC	$177.83	$194.98	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $239.88 / $309.03	Professional		$173.78	$239.88	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $41.69 / $60.26	Professional	26	$32.36	$41.69	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $194.98 / $269.15	Professional	TC	$138.04	$194.98	$269.15
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $239.88 / $407.38	Professional		$177.83	$239.88	$407.38
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $44.67 / $93.33	Professional	26	$33.11	$44.67	$93.33
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $199.53 / $309.03	Professional	TC	$144.54	$199.53	$309.03