Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.93 / $122.47 / $207.11	Professional		$34.93	$122.47	$207.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $20.93 / $32.56	Professional	26	$11.78	$20.93	$32.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.84 / $103.93 / $206.11	Professional	TC	$87.84	$103.93	$206.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $171.22 / $197.45 / $627.29	Professional		$171.22	$197.45	$627.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.89 / $27.73 / $90.64	Professional	26	$14.89	$27.73	$90.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.33 / $168.59 / $608.34	Professional	TC	$141.33	$168.59	$608.34
HMSA Facility/Professional Professional Modifier Low / Median / High Price $21.40 / $28.96 / $230.60	Professional		$21.40	$28.96	$230.60
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $23.46 / $24.57 / $25.18	Professional	26	$23.46	$24.57	$25.18
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $168.60 / $196.17 / $205.41	Professional	TC	$168.60	$196.17	$205.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $143.24 / $171.89 / $200.54	Professional		$143.24	$171.89	$200.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.53 / $25.84 / $30.14	Professional	26	$21.53	$25.84	$30.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $121.71 / $146.05 / $170.39	Professional	TC	$121.71	$146.05	$170.39
United Facility/Professional Professional Modifier Low / Median / High Price $142.59 / $171.76 / $265.16	Professional		$142.59	$171.76	$265.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.59 / $26.49 / $37.79	Professional	26	$20.59	$26.49	$37.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $119.53 / $149.69 / $227.36	Professional	TC	$119.53	$149.69	$227.36
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $128.32 / $165.30 / $322.05	Professional		$128.32	$165.30	$322.05
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $23.19 / $56.90	Professional	26	$14.36	$23.19	$56.90
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $107.98 / $144.83 / $260.45	Professional	TC	$107.98	$144.83	$260.45