Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.24 / $102.56 / $224.72	Professional		$93.24	$102.56	$224.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.48 / $40.44 / $146.19	Professional	26	$13.48	$40.44	$146.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.03 / $85.99 / $132.57	Professional	TC	$69.03	$85.99	$132.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.36 / $112.36 / $112.36	Professional		$112.36	$112.36	$112.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.58 / $14.58 / $14.58	Professional	26	$14.58	$14.58	$14.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.79 / $97.79 / $97.79	Professional	TC	$97.79	$97.79	$97.79
HMSA Facility/Professional Professional Modifier Low / Median / High Price $15.37 / $101.16 / $116.49	Professional		$15.37	$101.16	$116.49
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $17.27 / $18.07 / $25.45	Professional	26	$17.27	$18.07	$25.45
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $79.20 / $82.93 / $91.05	Professional	TC	$79.20	$82.93	$91.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $98.88 / $107.87 / $125.85	Professional		$98.88	$107.87	$125.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.83 / $13.99 / $16.32	Professional	26	$12.83	$13.99	$16.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $86.05 / $93.88 / $109.52	Professional	TC	$86.05	$93.88	$109.52
United Facility/Professional Professional Modifier Low / Median / High Price $112.36 / $112.36 / $130.21	Professional		$112.36	$112.36	$130.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.58 / $14.58 / $19.61	Professional	26	$14.58	$14.58	$19.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.79 / $97.79 / $110.60	Professional	TC	$97.79	$97.79	$110.60
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $58.09 / $109.40 / $144.02	Professional		$58.09	$109.40	$144.02
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $17.10 / $22.80	Professional	26	$11.26	$17.10	$22.80
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $43.48 / $94.55 / $122.29	Professional	TC	$43.48	$94.55	$122.29