Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $133.62 / $133.62 / $133.62	Professional	26	$133.62	$133.62	$133.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $155.01 / $155.01 / $155.01	Professional		$155.01	$155.01	$155.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.11 / $52.11 / $52.11	Professional	26	$52.11	$52.11	$52.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.90 / $102.90 / $102.90	Professional	TC	$102.90	$102.90	$102.90
HMSA Facility/Professional Professional Modifier Low / Median / High Price $63.04 / $195.21 / $332.04	Professional		$63.04	$195.21	$332.04
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $70.83 / $74.17 / $128.26	Professional	26	$70.83	$74.17	$128.26
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $115.60 / $121.05 / $203.80	Professional	TC	$115.60	$121.05	$203.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $136.41 / $148.81 / $173.61	Professional		$136.41	$148.81	$173.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.86 / $50.03 / $58.37	Professional	26	$45.86	$50.03	$58.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $90.55 / $98.78 / $115.25	Professional	TC	$90.55	$98.78	$115.25
United Facility/Professional Professional Modifier Low / Median / High Price $155.01 / $155.01 / $214.07	Professional		$155.01	$155.01	$214.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.11 / $52.11 / $72.53	Professional	26	$52.11	$52.11	$72.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.13 / $102.90 / $141.54	Professional	TC	$59.13	$102.90	$141.54
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $157.07 / $188.92 / $306.67	Professional		$157.07	$188.92	$306.67
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $54.15 / $63.87 / $108.91	Professional	26	$54.15	$63.87	$108.91
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $98.30 / $125.05 / $200.70	Professional	TC	$98.30	$125.05	$200.70