Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.04 / $35.18 / $41.39	Facility	26	$31.04	$35.18	$41.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.03 / $85.40 / $119.80	Professional		$67.03	$85.40	$119.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.13 / $26.28 / $48.36	Professional	26	$6.13	$26.28	$48.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.13 / $31.69 / $33.52	Professional	52	$30.13	$31.69	$33.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.63 / $43.74 / $71.43	Professional	TC	$19.63	$43.74	$71.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.11 / $96.32 / $205.61	Professional		$53.11	$96.32	$205.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.05 / $35.18 / $69.23	Professional	26	$24.05	$35.18	$69.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.05 / $56.94 / $136.37	Professional	TC	$29.05	$56.94	$136.37
HMSA Facility/Professional Professional Modifier Low / Median / High Price $36.97 / $122.04 / $131.33	Professional		$36.97	$122.04	$131.33
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $39.24 / $41.09 / $42.12	Professional	26	$39.24	$41.09	$42.12
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $85.20 / $89.21 / $89.21	Professional	TC	$85.20	$89.21	$89.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $80.12 / $87.41 / $101.98	Professional		$80.12	$87.41	$101.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.72 / $36.79 / $42.92	Professional	26	$33.72	$36.79	$42.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.40 / $50.62 / $59.05	Professional	TC	$46.40	$50.62	$59.05
United Facility/Professional Professional Modifier Low / Median / High Price $40.65 / $98.33 / $111.86	Professional		$40.65	$98.33	$111.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.04 / $41.39 / $50.19	Professional	26	$31.04	$41.39	$50.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.07 / $56.94 / $62.57	Professional	TC	$21.07	$56.94	$62.57
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $64.18 / $109.49 / $192.86	Professional		$64.18	$109.49	$192.86
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $30.21 / $43.50 / $77.53	Professional	26	$30.21	$43.50	$77.53
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $35.90 / $63.72 / $114.10	Professional	TC	$35.90	$63.72	$114.10