Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $81.28 / $173.78	Professional		$69.18	$81.28	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $44.67 / $213.80	Professional	26	$37.15	$44.67	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $38.90 / $56.23	Professional	TC	$20.89	$38.90	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $87.10 / $128.82	Professional		$53.70	$87.10	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $48.98 / $70.79	Professional	26	$38.02	$48.98	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $38.90 / $52.48	Professional	TC	$16.60	$38.90	$52.48
HMSA Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $60.26 / $112.20	Professional		$48.98	$60.26	$112.20
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $63.10 / $64.57	Professional	26	$60.26	$63.10	$64.57
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $48.98 / $48.98	Professional	TC	$46.77	$48.98	$48.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $102.33 / $120.23	Professional		$87.10	$102.33	$120.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $50.12 / $58.88	Professional	26	$42.66	$50.12	$58.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $52.48 / $60.26	Professional	TC	$44.67	$52.48	$60.26
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $100.00 / $120.23	Professional		$74.13	$100.00	$120.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $50.12 / $67.61	Professional	26	$40.74	$50.12	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $51.29 / $60.26	Professional	TC	$33.11	$51.29	$60.26
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $93.33 / $165.96	Professional		$64.57	$93.33	$165.96
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $50.12 / $83.18	Professional	26	$36.31	$50.12	$83.18
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $45.71 / $57.54	Professional	TC	$27.54	$45.71	$57.54