Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.16 / $53.16 / $148.96	Professional		$53.16	$53.16	$148.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.12 / $88.58 / $88.58	Professional	26	$22.12	$88.58	$88.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.02 / $31.02 / $109.46	Professional	TC	$31.02	$31.02	$109.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.41 / $112.41 / $112.41	Professional		$112.41	$112.41	$112.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.59 / $31.59 / $31.59	Professional	26	$31.59	$31.59	$31.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.83 / $80.83 / $80.83	Professional	TC	$80.83	$80.83	$80.83
HMSA Facility/Professional Professional Modifier Low / Median / High Price $31.61 / $92.30 / $120.27	Professional		$31.61	$92.30	$120.27
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $35.52 / $37.19 / $53.25	Professional	26	$35.52	$37.19	$53.25
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $54.95 / $67.04	Professional	TC	$52.48	$54.95	$67.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $98.92 / $107.92 / $125.90	Professional		$98.92	$107.92	$125.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.80 / $30.32 / $35.38	Professional	26	$27.80	$30.32	$35.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $71.13 / $77.59 / $90.52	Professional	TC	$71.13	$77.59	$90.52
United Facility/Professional Professional Modifier Low / Median / High Price $112.41 / $112.41 / $120.20	Professional		$112.41	$112.41	$120.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.59 / $42.44 / $42.44	Professional	26	$31.59	$42.44	$42.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.76 / $77.76 / $80.83	Professional	TC	$77.76	$77.76	$80.83
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $57.94 / $91.67 / $143.47	Professional		$57.94	$91.67	$143.47
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $23.66 / $35.09 / $49.96	Professional	26	$23.66	$35.09	$49.96
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $31.49 / $50.94 / $95.05	Professional	TC	$31.49	$50.94	$95.05