Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.98 / $115.98 / $115.98	Professional		$115.98	$115.98	$115.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.00 / $24.00 / $24.00	Professional	26	$24.00	$24.00	$24.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.98 / $91.98 / $91.98	Professional	TC	$91.98	$91.98	$91.98
HMSA Facility/Professional Professional Modifier Low / Median / High Price $28.60 / $129.19 / $197.11	Professional		$28.60	$129.19	$197.11
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $32.13 / $33.65 / $48.09	Professional	26	$32.13	$33.65	$48.09
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $91.17 / $95.47 / $149.03	Professional	TC	$91.17	$95.47	$149.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.06 / $111.34 / $129.88	Professional		$102.06	$111.34	$129.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.12 / $23.04 / $26.88	Professional	26	$21.12	$23.04	$26.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $80.94 / $88.30 / $103.01	Professional	TC	$80.94	$88.30	$103.01
United Facility/Professional Professional Modifier Low / Median / High Price $115.98 / $115.98 / $165.17	Professional		$115.98	$115.98	$165.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.00 / $24.00 / $36.00	Professional	26	$24.00	$24.00	$36.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.98 / $91.98 / $129.16	Professional	TC	$91.98	$91.98	$129.16
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $60.91 / $134.76 / $191.29	Professional		$60.91	$134.76	$191.29
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $21.32 / $30.45 / $43.21	Professional	26	$21.32	$30.45	$43.21
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $32.53 / $106.70 / $149.24	Professional	TC	$32.53	$106.70	$149.24