Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $219.67 / $219.67 / $267.56	Professional		$219.67	$219.67	$267.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.08 / $55.08 / $64.17	Professional	26	$55.08	$55.08	$64.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $164.59 / $164.59 / $203.38	Professional	TC	$164.59	$164.59	$203.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $201.65 / $201.65 / $201.65	Professional		$201.65	$201.65	$201.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.60 / $51.60 / $51.60	Professional	26	$51.60	$51.60	$51.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $150.05 / $150.05 / $150.05	Professional	TC	$150.05	$150.05	$150.05
HMSA Facility/Professional Professional Modifier Low / Median / High Price $88.34 / $161.26 / $267.77	Professional		$88.34	$161.26	$267.77
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $99.25 / $103.93 / $106.53	Professional	26	$99.25	$103.93	$106.53
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $154.00 / $161.26 / $161.26	Professional	TC	$154.00	$161.26	$161.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.45 / $193.58 / $225.85	Professional		$177.45	$193.58	$225.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.41 / $49.54 / $57.79	Professional	26	$45.41	$49.54	$57.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $132.04 / $144.05 / $168.06	Professional	TC	$132.04	$144.05	$168.06
United Facility/Professional Professional Modifier Low / Median / High Price $201.65 / $201.65 / $222.38	Professional		$201.65	$201.65	$222.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.60 / $51.60 / $67.47	Professional	26	$51.60	$51.60	$67.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.05 / $150.05 / $154.91	Professional	TC	$150.05	$150.05	$154.91
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $171.68 / $232.93 / $367.52	Professional		$171.68	$232.93	$367.52
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $48.00 / $68.22 / $120.91	Professional	26	$48.00	$68.22	$120.91
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $95.56 / $162.05 / $257.08	Professional	TC	$95.56	$162.05	$257.08