Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $165.29 / $187.33 / $229.58	Facility	26	$165.29	$187.33	$229.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $280.27 / $326.44 / $476.27	Professional		$280.27	$326.44	$476.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $156.71 / $183.39 / $287.54	Professional	26	$156.71	$183.39	$287.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.00 / $121.92 / $174.46	Professional	TC	$99.00	$121.92	$174.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.43 / $369.66 / $411.65	Professional		$301.43	$369.66	$411.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $187.33 / $230.27 / $243.64	Professional	26	$187.33	$230.27	$243.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.10 / $146.83 / $168.01	Professional	TC	$114.10	$146.83	$168.01
HMSA Facility/Professional Professional Modifier Low / Median / High Price $143.66 / $196.41 / $416.45	Professional		$143.66	$196.41	$416.45
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $230.55 / $241.41 / $247.44	Professional	26	$230.55	$241.41	$247.44
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $161.40 / $169.01 / $169.01	Professional	TC	$161.40	$169.01	$169.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $325.07 / $354.62 / $413.73	Professional		$325.07	$354.62	$413.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $202.03 / $220.39 / $257.12	Professional	26	$202.03	$220.39	$257.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.05 / $134.22 / $156.60	Professional	TC	$123.05	$134.22	$156.60
United Facility/Professional Professional Modifier Low / Median / High Price $301.43 / $369.40 / $501.95	Professional		$301.43	$369.40	$501.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $187.33 / $229.58 / $303.69	Professional	26	$187.33	$229.58	$303.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.10 / $139.83 / $198.26	Professional	TC	$114.10	$139.83	$198.26
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $234.24 / $372.95 / $414.94	Professional		$234.24	$372.95	$414.94
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $141.72 / $219.58 / $251.05	Professional	26	$141.72	$219.58	$251.05
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $92.52 / $150.66 / $163.89	Professional	TC	$92.52	$150.66	$163.89