Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $151.36 / $234.42	Professional		$128.82	$151.36	$234.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $83.18 / $112.20	Professional	26	$70.79	$83.18	$112.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $79.43 / $120.23	Professional	TC	$45.71	$79.43	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $173.78 / $245.47	Professional		$141.25	$173.78	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $102.33 / $120.23	Professional	26	$93.33	$102.33	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $85.11 / $125.89	Professional	TC	$38.02	$85.11	$125.89
HMSA Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $123.03 / $223.87	Professional		$100.00	$123.03	$223.87
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $109.65 / $112.20	Professional	26	$104.71	$109.65	$112.20
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $104.71 / $109.65	Professional	TC	$95.50	$104.71	$109.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $213.80 / $263.03	Professional		$194.98	$213.80	$263.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $100.00 / $125.89	Professional	26	$93.33	$100.00	$125.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $109.65 / $138.04	Professional	TC	$102.33	$109.65	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $181.97 / $208.93	Professional		$147.91	$181.97	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $97.72 / $104.71	Professional	26	$77.62	$97.72	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $93.33 / $104.71	Professional	TC	$48.98	$93.33	$104.71
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $173.78 / $229.09	Professional		$123.03	$173.78	$229.09
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $93.33 / $107.15	Professional	26	$60.26	$93.33	$107.15
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $85.11 / $123.03	Professional	TC	$33.88	$85.11	$123.03