Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $436.52 / $870.96	Professional		$288.40	$436.52	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $144.54 / $478.63	Professional	26	$75.86	$144.54	$478.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $199.53 / $316.23	Professional	TC	$154.88	$199.53	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $128.82 / $389.05	Professional		$87.10	$128.82	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $42.66 / $100.00	Professional	26	$41.69	$42.66	$100.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $89.13 / $288.40	Professional	TC	$43.65	$89.13	$288.40
HMSA Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $416.87 / $436.52	Professional		$223.87	$416.87	$436.52
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $117.49 / $169.82	Professional	26	$112.20	$117.49	$169.82
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $263.03 / $338.84	Professional	TC	$251.19	$263.03	$338.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $371.54 / $426.58	Professional		$338.84	$371.54	$426.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $95.50 / $112.20	Professional	26	$87.10	$95.50	$112.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $275.42 / $316.23	Professional	TC	$251.19	$275.42	$316.23
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $147.91 / $467.74	Professional		$104.71	$147.91	$467.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $51.29 / $134.90	Professional	26	$48.98	$51.29	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $100.00 / $331.13	Professional	TC	$52.48	$100.00	$331.13
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $363.08 / $478.63	Professional		$190.55	$363.08	$478.63
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $117.49 / $151.36	Professional	26	$89.13	$117.49	$151.36
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $245.47 / $354.81	Professional	TC	$89.13	$245.47	$354.81