Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.42 / $259.56 / $362.43	Facility		$41.42	$259.56	$362.43
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.40 / $11.78 / $13.86	Facility	26	$10.40	$11.78	$13.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.64 / $191.70 / $319.13	Facility	TC	$29.64	$191.70	$319.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.80 / $43.85 / $115.43	Professional		$29.80	$43.85	$115.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.40 / $17.48 / $43.35	Professional	26	$10.40	$17.48	$43.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.92 / $30.67 / $43.61	Professional	TC	$17.92	$30.67	$43.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $37.65 / $37.65 / $37.65	Facility		$37.65	$37.65	$37.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $26.10 / $26.10	Facility	TC	$26.10	$26.10	$26.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.61 / $40.51 / $48.74	Professional		$33.61	$40.51	$48.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $12.52 / $15.08	Professional	26	$11.78	$12.52	$15.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.09 / $26.32 / $34.86	Professional	TC	$21.09	$26.32	$34.86
HMSA Facility/Professional Professional Modifier Low / Median / High Price $12.31 / $16.64 / $48.79	Professional		$12.31	$16.64	$48.79
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $14.13 / $14.48	Professional	26	$13.49	$14.13	$14.48
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $33.10 / $34.65 / $34.65	Professional	TC	$33.10	$34.65	$34.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.71 / $43.32 / $50.54	Professional		$39.71	$43.32	$50.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.30 / $12.32 / $14.38	Professional	26	$11.30	$12.32	$14.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.41 / $31.00 / $32.79	Professional	TC	$28.41	$31.00	$32.79
United Facility/Professional Professional Modifier Low / Median / High Price $17.97 / $44.98 / $54.80	Professional		$17.97	$44.98	$54.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.07 / $17.28 / $87.90	Professional	26	$11.07	$17.28	$87.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.94 / $37.52 / $159.00	Professional	TC	$21.94	$37.52	$159.00
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $42.44 / $53.67 / $78.09	Professional		$42.44	$53.67	$78.09
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $12.70 / $16.07 / $26.34	Professional	26	$12.70	$16.07	$26.34
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $28.13 / $38.03 / $51.75	Professional	TC	$28.13	$38.03	$51.75