Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $164.90 / $164.90 / $164.90	Professional	26	$164.90	$164.90	$164.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.79 / $87.79 / $87.79	Professional		$87.79	$87.79	$87.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.43 / $30.43 / $30.43	Professional	26	$30.43	$30.43	$30.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.38 / $57.38 / $57.38	Professional	TC	$57.38	$57.38	$57.38
HMSA Facility/Professional Professional Modifier Low / Median / High Price $24.09 / $55.75 / $88.88	Professional		$24.09	$55.75	$88.88
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $27.06 / $28.34 / $29.05	Professional	26	$27.06	$28.34	$29.05
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $57.14 / $58.38 / $59.83	Professional	TC	$57.14	$58.38	$59.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $77.25 / $84.28 / $98.32	Professional		$77.25	$84.28	$98.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.77 / $29.21 / $34.08	Professional	26	$26.77	$29.21	$34.08
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $50.49 / $55.08 / $64.26	Professional	TC	$50.49	$55.08	$64.26
United Facility/Professional Professional Modifier Low / Median / High Price $87.79 / $124.22 / $124.22	Professional		$87.79	$124.22	$124.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.43 / $30.43 / $43.08	Professional	26	$30.43	$30.43	$43.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.38 / $57.38 / $81.14	Professional	TC	$57.38	$57.38	$81.14
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $73.76 / $107.72 / $167.74	Professional		$73.76	$107.72	$167.74
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $24.09 / $36.10 / $54.68	Professional	26	$24.09	$36.10	$54.68
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $49.67 / $71.62 / $111.67	Professional	TC	$49.67	$71.62	$111.67