Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $988.00 / $2,898.00 / $3,444.00	Facility		$988.00	$2,898.00	$3,444.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.13 / $241.08 / $672.00	Professional		$140.13	$241.08	$672.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.79 / $43.81 / $182.80	Professional	26	$40.79	$43.81	$182.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.29 / $108.87 / $178.40	Professional	TC	$81.29	$108.87	$178.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.55 / $224.88 / $224.88	Professional		$114.55	$224.88	$224.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.17 / $47.88 / $72.42	Professional	26	$39.17	$47.88	$72.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.39 / $177.00 / $177.00	Professional	TC	$75.39	$177.00	$177.00
HMSA Facility/Professional Professional Modifier Low / Median / High Price $141.38 / $336.68 / $413.20	Professional		$141.38	$336.68	$413.20
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $147.77 / $158.85 / $166.34	Professional	26	$147.77	$158.85	$166.34
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $297.95 / $320.30 / $335.39	Professional	TC	$297.95	$320.30	$335.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $197.89 / $215.88 / $251.86	Professional		$197.89	$215.88	$251.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.13 / $45.96 / $53.62	Professional	26	$42.13	$45.96	$53.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $155.76 / $169.92 / $198.24	Professional	TC	$155.76	$169.92	$198.24
United Facility/Professional Facility Modifier Low / Median / High Price $1,078.00 / $1,078.00 / $1,078.00	Facility		$1,078.00	$1,078.00	$1,078.00
United Facility/Professional Professional Modifier Low / Median / High Price $183.50 / $224.88 / $277.35	Professional		$183.50	$224.88	$277.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.07 / $48.98 / $63.69	Professional	26	$39.07	$48.98	$63.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.43 / $177.00 / $213.66	Professional	TC	$144.43	$177.00	$213.66
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $29.58 / $210.79 / $330.36	Professional		$29.58	$210.79	$330.36
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $6.79 / $48.40 / $143.50	Professional	26	$6.79	$48.40	$143.50
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $22.79 / $162.38 / $368.94	Professional	TC	$22.79	$162.38	$368.94