Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.35 / $559.54 / $833.18	Professional		$213.35	$559.54	$833.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.06 / $63.94 / $227.96	Professional	26	$12.06	$63.94	$227.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.34 / $361.50 / $686.43	Professional	TC	$168.34	$361.50	$686.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $198.57 / $449.99 / $619.92	Professional		$198.57	$449.99	$619.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.84 / $69.81 / $71.42	Professional	26	$56.84	$69.81	$71.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $127.15 / $379.94 / $550.26	Professional	TC	$127.15	$379.94	$550.26
HMSA Facility/Professional Professional Modifier Low / Median / High Price $65.92 / $470.60 / $549.32	Professional		$65.92	$470.60	$549.32
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $72.25 / $75.65 / $77.55	Professional	26	$72.25	$75.65	$77.55
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $450.54 / $471.77 / $471.77	Professional	TC	$450.54	$471.77	$471.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $545.53 / $595.13 / $694.32	Professional		$545.53	$595.13	$694.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.30 / $66.88 / $78.02	Professional	26	$61.30	$66.88	$78.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $484.23 / $528.25 / $616.29	Professional	TC	$484.23	$528.25	$616.29
United Facility/Professional Professional Modifier Low / Median / High Price $440.95 / $535.62 / $746.63	Professional		$440.95	$535.62	$746.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.84 / $69.66 / $92.76	Professional	26	$56.84	$69.66	$92.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $381.98 / $477.29 / $653.87	Professional	TC	$381.98	$477.29	$653.87
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $205.75 / $570.41 / $684.28	Professional		$205.75	$570.41	$684.28
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $42.20 / $64.03 / $74.75	Professional	26	$42.20	$64.03	$74.75
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $142.76 / $431.58 / $569.91	Professional	TC	$142.76	$431.58	$569.91