Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.95 / $75.95 / $211.69	Professional		$75.95	$75.95	$211.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.96 / $93.92 / $311.10	Professional	26	$46.96	$93.92	$311.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.00 / $74.00 / $148.97	Professional	TC	$74.00	$74.00	$148.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $160.26 / $160.26 / $160.26	Professional		$160.26	$160.26	$160.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.39 / $50.39 / $50.39	Professional	26	$50.39	$50.39	$50.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.86 / $109.86 / $109.86	Professional	TC	$109.86	$109.86	$109.86
HMSA Facility/Professional Professional Modifier Low / Median / High Price $71.48 / $183.29 / $251.88	Professional		$71.48	$183.29	$251.88
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $80.31 / $84.09 / $129.06	Professional	26	$80.31	$84.09	$129.06
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $94.36 / $98.81 / $122.83	Professional	TC	$94.36	$98.81	$122.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.03 / $153.85 / $179.49	Professional		$141.03	$153.85	$179.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.34 / $48.37 / $56.43	Professional	26	$44.34	$48.37	$56.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $96.68 / $105.47 / $123.05	Professional	TC	$96.68	$105.47	$123.05
United Facility/Professional Professional Modifier Low / Median / High Price $160.26 / $160.26 / $211.73	Professional		$160.26	$160.26	$211.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.39 / $50.39 / $68.94	Professional	26	$50.39	$50.39	$68.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.86 / $109.86 / $142.79	Professional	TC	$109.86	$109.86	$142.79
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $125.00 / $174.15 / $264.86	Professional		$125.00	$174.15	$264.86
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $48.60 / $61.23 / $101.12	Professional	26	$48.60	$61.23	$101.12
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $68.63 / $115.50 / $179.43	Professional	TC	$68.63	$115.50	$179.43