Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $509.40 / $509.40 / $509.40	Facility		$509.40	$509.40	$509.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $172.21 / $211.82 / $402.82	Professional		$172.21	$211.82	$402.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.94 / $55.46 / $103.37	Professional	26	$47.94	$55.46	$103.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $122.52 / $156.36 / $196.80	Professional	TC	$122.52	$156.36	$196.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $140.80 / $235.98 / $288.74	Professional		$140.80	$235.98	$288.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.83 / $68.75 / $77.18	Professional	26	$38.83	$68.75	$77.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.97 / $167.23 / $211.57	Professional	TC	$101.97	$167.23	$211.57
HMSA Facility/Professional Professional Modifier Low / Median / High Price $61.81 / $222.62 / $267.76	Professional		$61.81	$222.62	$267.76
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $65.15 / $69.45 / $72.72	Professional	26	$65.15	$69.45	$72.72
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $186.26 / $195.04 / $195.04	Professional	TC	$186.26	$195.04	$195.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.84 / $165.65 / $193.26	Professional		$151.84	$165.65	$193.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.88 / $45.68 / $53.30	Professional	26	$41.88	$45.68	$53.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $109.97 / $119.96 / $139.96	Professional	TC	$109.97	$119.96	$139.96
United Facility/Professional Professional Modifier Low / Median / High Price $140.80 / $172.55 / $282.41	Professional		$140.80	$172.55	$282.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.83 / $47.59 / $65.91	Professional	26	$38.83	$47.59	$65.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $101.97 / $124.96 / $216.50	Professional	TC	$101.97	$124.96	$216.50
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $127.94 / $208.36 / $292.95	Professional		$127.94	$208.36	$292.95
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $30.04 / $49.78 / $59.34	Professional	26	$30.04	$49.78	$59.34
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $97.90 / $146.96 / $181.05	Professional	TC	$97.90	$146.96	$181.05