Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.84 / $100.05 / $153.38	Professional		$25.84	$100.05	$153.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.55 / $24.71 / $34.03	Professional	26	$22.55	$24.71	$34.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.26 / $112.49 / $175.65	Professional	TC	$102.26	$112.49	$175.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $131.97 / $131.97 / $131.97	Facility		$131.97	$131.97	$131.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.38 / $157.46 / $303.45	Professional		$106.38	$157.46	$303.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.91 / $27.70 / $51.34	Professional	26	$21.91	$27.70	$51.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.47 / $129.60 / $268.54	Professional	TC	$84.47	$129.60	$268.54
HMSA Facility/Professional Professional Modifier Low / Median / High Price $26.84 / $158.55 / $182.79	Professional		$26.84	$158.55	$182.79
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $28.75 / $30.10 / $30.85	Professional	26	$28.75	$30.10	$30.85
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $129.80 / $135.91 / $160.54	Professional	TC	$129.80	$135.91	$160.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.57 / $151.16 / $176.36	Professional		$138.57	$151.16	$176.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.51 / $26.74 / $31.19	Professional	26	$24.51	$26.74	$31.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $114.05 / $124.42 / $145.15	Professional	TC	$114.05	$124.42	$145.15
United Facility/Professional Professional Modifier Low / Median / High Price $113.37 / $157.46 / $205.91	Professional		$113.37	$157.46	$205.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.73 / $27.85 / $38.00	Professional	26	$22.73	$27.85	$38.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.31 / $129.60 / $167.91	Professional	TC	$93.31	$129.60	$167.91
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $115.76 / $151.87 / $319.22	Professional		$115.76	$151.87	$319.22
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $20.55 / $25.32 / $58.72	Professional	26	$20.55	$25.32	$58.72
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $95.21 / $126.55 / $260.50	Professional	TC	$95.21	$126.55	$260.50