Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.03 / $123.18 / $249.78	Professional		$75.03	$123.18	$249.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.96 / $68.80 / $255.00	Professional	26	$34.96	$68.80	$255.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.67 / $81.05 / $104.55	Professional	TC	$57.67	$81.05	$104.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.88 / $151.88 / $151.88	Professional		$151.88	$151.88	$151.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.46 / $42.46 / $42.46	Professional	26	$42.46	$42.46	$42.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.40 / $109.40 / $109.40	Professional	TC	$109.40	$109.40	$109.40
HMSA Facility/Professional Professional Modifier Low / Median / High Price $53.87 / $180.27 / $193.52	Professional		$53.87	$180.27	$193.52
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $60.53 / $63.38 / $90.50	Professional	26	$60.53	$63.38	$90.50
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $98.38 / $103.02 / $125.49	Professional	TC	$98.38	$103.02	$125.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $133.65 / $145.80 / $170.10	Professional		$133.65	$145.80	$170.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.36 / $40.76 / $47.56	Professional	26	$37.36	$40.76	$47.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $96.27 / $105.02 / $122.53	Professional	TC	$96.27	$105.02	$122.53
United Facility/Professional Professional Modifier Low / Median / High Price $57.30 / $151.88 / $178.16	Professional		$57.30	$151.88	$178.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.46 / $42.46 / $57.68	Professional	26	$42.46	$42.46	$57.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.40 / $109.40 / $120.48	Professional	TC	$109.40	$109.40	$120.48
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $93.89 / $141.93 / $216.41	Professional		$93.89	$141.93	$216.41
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $39.78 / $54.76 / $78.26	Professional	26	$39.78	$54.76	$78.26
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $43.83 / $91.30 / $148.38	Professional	TC	$43.83	$91.30	$148.38