Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.15 / $12.63 / $14.86	Facility	26	$11.15	$12.63	$14.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.82 / $55.02 / $383.20	Facility	TC	$40.82	$55.02	$383.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.90 / $54.93 / $173.24	Professional		$37.90	$54.93	$173.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.32 / $15.39 / $30.78	Professional	26	$11.32	$15.39	$30.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $124.11 / $382.50 / $414.00	Professional	50	$124.11	$382.50	$414.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.41 / $15.41 / $15.41	Professional	52	$15.41	$15.41	$15.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $41.37 / $60.33	Professional	TC	$27.87	$41.37	$60.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.66 / $12.66 / $12.66	Facility	26	$12.66	$12.66	$12.66
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $40.63 / $40.63 / $40.63	Facility	TC	$40.63	$40.63	$40.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.11 / $45.88 / $70.56	Professional		$37.11	$45.88	$70.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.14 / $12.95 / $16.52	Professional	26	$12.14	$12.95	$16.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.97 / $33.43 / $54.43	Professional	TC	$24.97	$33.43	$54.43
HMSA Facility/Professional Professional Modifier Low / Median / High Price $13.05 / $47.99 / $76.72	Professional		$13.05	$47.99	$76.72
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $14.30 / $14.97 / $15.35	Professional	26	$14.30	$14.97	$15.35
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $50.96 / $58.61 / $61.37	Professional	TC	$50.96	$58.61	$61.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $56.47 / $61.61 / $71.88	Professional		$56.47	$61.61	$71.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.11 / $13.21 / $15.41	Professional	26	$12.11	$13.21	$15.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.35 / $48.38 / $51.21	Professional	TC	$44.35	$48.38	$51.21
United Facility/Professional Professional Modifier Low / Median / High Price $23.88 / $69.31 / $74.00	Professional		$23.88	$69.31	$74.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.51 / $14.86 / $17.91	Professional	26	$6.51	$14.86	$17.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.37 / $43.54 / $56.09	Professional	TC	$17.37	$43.54	$56.09
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $45.26 / $73.03 / $102.74	Professional		$45.26	$73.03	$102.74
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $11.43 / $16.35 / $27.28	Professional	26	$11.43	$16.35	$27.28
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $35.39 / $53.10 / $75.45	Professional	TC	$35.39	$53.10	$75.45