Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $91.20 / $100.00	Professional		$53.70	$91.20	$100.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $38.90 / $165.96	Professional	26	$19.95	$38.90	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $56.23 / $63.10	Professional	TC	$33.11	$56.23	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $32.36 / $87.10	Professional		$30.20	$32.36	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $13.80 / $30.20	Professional	26	$10.96	$13.80	$30.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $22.39 / $57.54	Professional	TC	$19.05	$22.39	$57.54
HMSA Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $56.23 / $89.13	Professional		$25.70	$56.23	$89.13
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $28.18 / $28.84	Professional	26	$26.92	$28.18	$28.84
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $58.88 / $60.26	Professional	TC	$57.54	$58.88	$60.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $83.18 / $97.72	Professional		$75.86	$83.18	$97.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $29.51 / $33.88	Professional	26	$26.92	$29.51	$33.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $53.70 / $63.10	Professional	TC	$48.98	$53.70	$63.10
United Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $40.74 / $123.03	Professional		$36.31	$40.74	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $15.85 / $42.66	Professional	26	$13.18	$15.85	$42.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $24.55 / $81.28	Professional	TC	$22.91	$24.55	$81.28
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $107.15 / $165.96	Professional		$74.13	$107.15	$165.96
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $36.31 / $54.95	Professional	26	$23.99	$36.31	$54.95
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $69.18 / $112.20	Professional	TC	$50.12	$69.18	$112.20