Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $51.85 / $143.74 / $355.70	Facility		$51.85	$143.74	$355.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.77 / $12.21 / $14.36	Facility	26	$10.77	$12.21	$14.36
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $41.57 / $56.06 / $372.80	Facility	TC	$41.57	$56.06	$372.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.95 / $50.55 / $85.32	Professional		$10.95	$50.55	$85.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.19 / $14.31 / $31.96	Professional	26	$2.19	$14.31	$31.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $42.26 / $55.43	Professional	TC	$27.55	$42.26	$55.43
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.31 / $53.31 / $53.31	Facility		$53.31	$53.31	$53.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $41.38 / $41.38 / $41.38	Facility	TC	$41.38	$41.38	$41.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $49.46 / $69.81	Professional		$24.55	$49.46	$69.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.21 / $12.91 / $15.62	Professional	26	$12.21	$12.91	$15.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.27 / $40.46 / $55.43	Professional	TC	$32.27	$40.46	$55.43
HMSA Facility/Professional Professional Modifier Low / Median / High Price $13.20 / $51.91 / $68.95	Professional		$13.20	$51.91	$68.95
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $13.92 / $14.83 / $15.53	Professional	26	$13.92	$14.83	$15.53
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $51.92 / $54.37 / $56.50	Professional	TC	$51.92	$54.37	$56.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $56.88 / $62.05 / $72.39	Professional		$56.88	$62.05	$72.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.70 / $12.77 / $14.90	Professional	26	$11.70	$12.77	$14.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $45.17 / $49.27 / $52.15	Professional	TC	$45.17	$49.27	$52.15
United Facility/Professional Professional Modifier Low / Median / High Price $24.64 / $60.66 / $76.47	Professional		$24.64	$60.66	$76.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.51 / $14.36 / $17.91	Professional	26	$6.51	$14.36	$17.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.13 / $55.43 / $58.56	Professional	TC	$18.13	$55.43	$58.56
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $60.61 / $76.90 / $107.50	Professional		$60.61	$76.90	$107.50
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $13.16 / $16.88 / $27.28	Professional	26	$13.16	$16.88	$27.28
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $45.18 / $60.45 / $80.22	Professional	TC	$45.18	$60.45	$80.22