Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $134.90 / $524.81	Professional		$107.15	$134.90	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $33.88 / $138.04	Professional	26	$23.44	$33.88	$138.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $95.50 / $144.54	Professional	TC	$79.43	$95.50	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $134.90 / $309.03	Professional		$89.13	$134.90	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $30.20 / $54.95	Professional	26	$23.44	$30.20	$54.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $104.71 / $257.04	Professional	TC	$66.07	$104.71	$257.04
HMSA Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $194.98 / $2,398.83	Professional		$125.89	$194.98	$2,398.83
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $42.66 / $44.67	Professional	26	$40.74	$42.66	$44.67
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $147.91 / $147.91	Professional	TC	$141.25	$147.91	$147.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $134.90 / $158.49	Professional		$123.03	$134.90	$158.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $30.20 / $35.48	Professional	26	$28.18	$30.20	$35.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $104.71 / $120.23	Professional	TC	$95.50	$104.71	$120.23
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $128.82 / $177.83	Professional		$95.50	$128.82	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $30.90 / $38.90	Professional	26	$21.88	$30.90	$38.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $97.72 / $141.25	Professional	TC	$72.44	$97.72	$141.25
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $131.83 / $346.74	Professional		$95.50	$131.83	$346.74
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $30.90 / $53.70	Professional	26	$22.39	$30.90	$53.70
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $100.00 / $186.21	Professional	TC	$72.44	$100.00	$186.21