Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.98 / $64.34 / $259.00	Professional		$54.98	$64.34	$259.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.65 / $27.91 / $41.39	Professional	26	$24.65	$27.91	$41.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.81 / $33.03 / $41.48	Professional	TC	$27.81	$33.03	$41.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.10 / $77.41 / $259.06	Professional		$60.10	$77.41	$259.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.74 / $34.01 / $58.73	Professional	26	$27.74	$34.01	$58.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.43 / $42.84 / $158.26	Professional	TC	$28.43	$42.84	$158.26
HMSA Facility/Professional Professional Modifier Low / Median / High Price $34.11 / $229.52 / $259.06	Professional		$34.11	$229.52	$259.06
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $38.27 / $39.22	Professional	26	$36.54	$38.27	$39.22
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $208.65 / $218.48 / $219.84	Professional	TC	$208.65	$218.48	$219.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.98 / $80.34 / $93.74	Professional		$70.98	$80.34	$93.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.44 / $32.20 / $37.56	Professional	26	$28.44	$32.20	$37.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.54 / $48.16 / $56.18	Professional	TC	$42.54	$48.16	$56.18
United Facility/Professional Professional Modifier Low / Median / High Price $51.77 / $76.87 / $127.83	Professional		$51.77	$76.87	$127.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.61 / $33.54 / $45.14	Professional	26	$25.61	$33.54	$45.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.66 / $41.28 / $58.47	Professional	TC	$26.66	$41.28	$58.47
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $58.43 / $78.36 / $134.12	Professional		$58.43	$78.36	$134.12
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $24.95 / $33.46 / $55.00	Professional	26	$24.95	$33.46	$55.00
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $33.47 / $44.90 / $76.18	Professional	TC	$33.47	$44.90	$76.18