Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.45 / $118.39 / $129.43	Professional		$87.45	$118.39	$129.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.59 / $81.62 / $83.24	Professional	26	$67.59	$81.62	$83.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.87 / $32.81 / $36.77	Professional	TC	$19.87	$32.81	$36.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.21 / $109.25 / $136.13	Professional		$84.21	$109.25	$136.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.29 / $75.23 / $95.95	Professional	26	$65.29	$75.23	$95.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.92 / $27.16 / $40.18	Professional	TC	$18.92	$27.16	$40.18
HMSA Facility/Professional Professional Modifier Low / Median / High Price $37.14 / $134.88 / $149.63	Professional		$37.14	$134.88	$149.63
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $97.75 / $102.36 / $104.92	Professional	26	$97.75	$102.36	$104.92
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $38.89 / $42.72 / $44.73	Professional	TC	$38.89	$42.72	$44.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $119.79 / $119.79 / $152.46	Professional		$119.79	$119.79	$152.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.44 / $84.44 / $107.46	Professional	26	$84.44	$84.44	$107.46
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.35 / $35.35 / $45.00	Professional	TC	$35.35	$35.35	$45.00
United Facility/Professional Professional Modifier Low / Median / High Price $73.09 / $111.08 / $175.45	Professional		$73.09	$111.08	$175.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.43 / $95.95 / $127.40	Professional	26	$73.43	$95.95	$127.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.06 / $34.71 / $48.05	Professional	TC	$25.06	$34.71	$48.05
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $85.14 / $138.66 / $158.57	Professional		$85.14	$138.66	$158.57
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $57.84 / $94.20 / $122.15	Professional	26	$57.84	$94.20	$122.15
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $27.30 / $36.44 / $45.24	Professional	TC	$27.30	$36.44	$45.24