Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.63 / $139.83 / $698.70	Professional		$56.63	$139.83	$698.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.32 / $54.82 / $323.00	Professional	26	$5.32	$54.82	$323.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.51 / $119.00 / $318.42	Professional	TC	$95.51	$119.00	$318.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.66 / $151.66 / $151.66	Professional		$151.66	$151.66	$151.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.29 / $32.29 / $32.29	Professional	26	$32.29	$32.29	$32.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $119.39 / $119.39 / $119.39	Professional	TC	$119.39	$119.39	$119.39
HMSA Facility/Professional Professional Modifier Low / Median / High Price $35.89 / $148.29 / $161.16	Professional		$35.89	$148.29	$161.16
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $40.32 / $42.22 / $57.63	Professional	26	$40.32	$42.22	$57.63
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $98.86 / $103.52 / $106.07	Professional	TC	$98.86	$103.52	$106.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $133.46 / $145.60 / $169.86	Professional		$133.46	$145.60	$169.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.41 / $31.00 / $36.15	Professional	26	$28.41	$31.00	$36.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $105.06 / $114.61 / $133.71	Professional	TC	$105.06	$114.61	$133.71
United Facility/Professional Professional Modifier Low / Median / High Price $54.80 / $151.66 / $179.36	Professional		$54.80	$151.66	$179.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.29 / $32.29 / $43.38	Professional	26	$32.29	$32.29	$43.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $119.39 / $135.97 / $135.97	Professional	TC	$119.39	$135.97	$135.97
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $84.98 / $151.18 / $193.66	Professional		$84.98	$151.18	$193.66
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $25.31 / $37.86 / $51.56	Professional	26	$25.31	$37.86	$51.56
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $51.37 / $117.37 / $144.06	Professional	TC	$51.37	$117.37	$144.06