Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $100.00 / $162.18	Professional		$64.57	$100.00	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $18.20 / $29.51	Professional	26	$14.13	$18.20	$29.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $81.28 / $134.90	Professional	TC	$50.12	$81.28	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $93.33 / $194.98	Professional		$66.07	$93.33	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $22.91 / $38.02	Professional	26	$15.49	$22.91	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $69.18 / $158.49	Professional	TC	$48.98	$69.18	$158.49
HMSA Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $173.78 / $194.98	Professional		$144.54	$173.78	$194.98
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $24.55 / $25.70	Professional	26	$23.99	$24.55	$25.70
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $147.91 / $169.82	Professional	TC	$141.25	$147.91	$169.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $151.36 / $177.83	Professional		$141.25	$151.36	$177.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $23.44 / $26.92	Professional	26	$21.38	$23.44	$26.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $128.82 / $151.36	Professional	TC	$117.49	$128.82	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $138.04 / $218.78	Professional		$95.50	$138.04	$218.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $25.12 / $38.90	Professional	26	$22.39	$25.12	$38.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $114.82 / $181.97	Professional	TC	$72.44	$114.82	$181.97
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $154.88 / $218.78	Professional		$89.13	$154.88	$218.78
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $28.18 / $38.90	Professional	26	$20.42	$28.18	$38.90
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $120.23 / $181.97	Professional	TC	$64.57	$120.23	$181.97