Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.63 / $81.65 / $98.53	Professional		$81.63	$81.65	$98.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.52 / $31.00 / $142.80	Professional	26	$5.52	$31.00	$142.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.07 / $48.07 / $77.11	Professional	TC	$48.07	$48.07	$77.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $90.46 / $90.46 / $90.46	Professional		$90.46	$90.46	$90.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $33.54 / $33.54	Professional	26	$33.54	$33.54	$33.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.90 / $56.90 / $56.90	Professional	TC	$56.90	$56.90	$56.90
HMSA Facility/Professional Professional Modifier Low / Median / High Price $68.48 / $169.77 / $241.13	Professional		$68.48	$169.77	$241.13
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $85.18 / $89.20 / $125.18	Professional	26	$85.18	$89.20	$125.18
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $76.95 / $80.58 / $115.95	Professional	TC	$76.95	$80.58	$115.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $79.61 / $86.84 / $101.32	Professional		$79.61	$86.84	$101.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.52 / $32.21 / $37.58	Professional	26	$29.52	$32.21	$37.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $50.07 / $54.62 / $63.73	Professional	TC	$50.07	$54.62	$63.73
United Facility/Professional Professional Modifier Low / Median / High Price $90.46 / $90.46 / $112.94	Professional		$90.46	$90.46	$112.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $33.54 / $45.09	Professional	26	$33.54	$33.54	$45.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.90 / $67.84 / $67.84	Professional	TC	$56.90	$67.84	$67.84
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $83.14 / $136.07 / $207.43	Professional		$83.14	$136.07	$207.43
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $61.85 / $103.55	Professional	26	$32.36	$61.85	$103.55
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $50.19 / $68.30 / $103.90	Professional	TC	$50.19	$68.30	$103.90