Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $35.99 / $80.36 / $315.45	Facility		$35.99	$80.36	$315.45
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.09 / $10.30 / $12.12	Facility	26	$9.09	$10.30	$12.12
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.61 / $256.67 / $287.08	Facility	TC	$32.61	$256.67	$287.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.54 / $40.88 / $115.00	Professional		$12.54	$40.88	$115.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.98 / $12.54 / $30.86	Professional	26	$8.98	$12.54	$30.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $90.30 / $90.30 / $90.30	Professional	50	$90.30	$90.30	$90.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $39.53 / $69.94	Professional	TC	$19.14	$39.53	$69.94
Cigna Facility/Professional Facility Modifier Low / Median / High Price $39.14 / $39.14 / $39.14	Facility		$39.14	$39.14	$39.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $20.45 / $33.13 / $50.49	Professional		$20.45	$33.13	$50.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.08 / $10.71 / $13.47	Professional	26	$10.08	$10.71	$13.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.91 / $24.76 / $38.38	Professional	TC	$21.91	$24.76	$38.38
HMSA Facility/Professional Professional Modifier Low / Median / High Price $10.78 / $41.94 / $50.88	Professional		$10.78	$41.94	$50.88
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $11.82 / $12.38 / $12.68	Professional	26	$11.82	$12.38	$12.68
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $36.47 / $38.20 / $38.20	Professional	TC	$36.47	$38.20	$38.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $41.14 / $44.88 / $52.36	Professional		$41.14	$44.88	$52.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.88 / $10.78 / $12.57	Professional	26	$9.88	$10.78	$12.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.27 / $34.11 / $36.11	Professional	TC	$31.27	$34.11	$36.11
United Facility/Professional Professional Modifier Low / Median / High Price $18.09 / $50.49 / $55.72	Professional		$18.09	$50.49	$55.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.49 / $12.12 / $15.11	Professional	26	$5.49	$12.12	$15.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $12.60 / $28.58 / $40.61	Professional	TC	$12.60	$28.58	$40.61
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $36.42 / $54.95 / $75.72	Professional		$36.42	$54.95	$75.72
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $9.41 / $13.36 / $23.02	Professional	26	$9.41	$13.36	$23.02
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $25.42 / $36.72 / $52.69	Professional	TC	$25.42	$36.72	$52.69