Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.53 / $50.27 / $208.00	Professional		$47.53	$50.27	$208.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.31 / $28.87 / $108.98	Professional	26	$25.31	$28.87	$108.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.67 / $21.45 / $63.87	Professional	TC	$18.67	$21.45	$63.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.94 / $63.59 / $87.27	Professional		$37.94	$63.59	$87.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.07 / $30.66 / $42.03	Professional	26	$21.07	$30.66	$42.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.51 / $29.88 / $47.15	Professional	TC	$14.51	$29.88	$47.15
HMSA Facility/Professional Professional Modifier Low / Median / High Price $34.64 / $44.68 / $82.79	Professional		$34.64	$44.68	$82.79
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $37.10 / $38.85 / $39.82	Professional	26	$37.10	$38.85	$39.82
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $43.94 / $43.94 / $43.94	Professional	TC	$43.94	$43.94	$43.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.59 / $74.81 / $87.28	Professional		$63.59	$74.81	$87.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.11 / $29.54 / $34.47	Professional	26	$25.11	$29.54	$34.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.47 / $45.26 / $52.81	Professional	TC	$38.47	$45.26	$52.81
United Facility/Professional Professional Modifier Low / Median / High Price $54.56 / $77.93 / $110.76	Professional		$54.56	$77.93	$110.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.11 / $30.78 / $74.06	Professional	26	$25.11	$30.78	$74.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.40 / $45.78 / $47.42	Professional	TC	$26.40	$45.78	$47.42
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $49.21 / $71.25 / $112.60	Professional		$49.21	$71.25	$112.60
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $22.29 / $30.72 / $55.68	Professional	26	$22.29	$30.72	$55.68
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $21.32 / $40.74 / $53.75	Professional	TC	$21.32	$40.74	$53.75