Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.70 / $57.46 / $67.59	Facility		$50.70	$57.46	$67.59
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.94 / $35.07 / $41.26	Facility	26	$30.94	$35.07	$41.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.59 / $92.48 / $135.43	Professional		$64.59	$92.48	$135.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.09 / $48.42 / $180.23	Professional	26	$40.09	$48.42	$180.23
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $82.23 / $94.51 / $179.00	Professional	50	$82.23	$94.51	$179.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.46 / $36.89 / $45.95	Professional	TC	$32.46	$36.89	$45.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.68 / $53.68 / $53.68	Facility		$53.68	$53.68	$53.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $34.29	Facility	26	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.96 / $75.11 / $191.96	Professional		$37.96	$75.11	$191.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.36 / $45.84 / $117.73	Professional	26	$24.36	$45.84	$117.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.59 / $29.27 / $79.70	Professional	TC	$13.59	$29.27	$79.70
HMSA Facility/Professional Professional Modifier Low / Median / High Price $55.71 / $162.66 / $183.14	Professional		$55.71	$162.66	$183.14
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $52.99 / $55.49 / $64.04	Professional	26	$52.99	$55.49	$64.04
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $113.57 / $118.92 / $119.10	Professional	TC	$113.57	$118.92	$119.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $55.08 / $60.08 / $70.09	Professional		$55.08	$60.08	$70.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.61 / $36.67 / $42.78	Professional	26	$33.61	$36.67	$42.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.46 / $23.41 / $27.31	Professional	TC	$21.46	$23.41	$27.31
United Facility/Professional Professional Modifier Low / Median / High Price $53.77 / $67.59 / $110.06	Professional		$53.77	$67.59	$110.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $41.26 / $79.16	Professional	26	$32.11	$41.26	$79.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.56 / $26.34 / $58.45	Professional	TC	$21.56	$26.34	$58.45
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $60.27 / $99.12 / $205.49	Professional		$60.27	$99.12	$205.49
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $37.00 / $51.78 / $103.28	Professional	26	$37.00	$51.78	$103.28
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $23.27 / $46.58 / $113.68	Professional	TC	$23.27	$46.58	$113.68