Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $112.20 / $478.63	Facility		$93.33	$112.20	$478.63
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $31.62 / $37.15	Facility	26	$27.54	$31.62	$37.15
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $66.07 / $89.13 / $467.74	Facility	TC	$66.07	$89.13	$467.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $120.23 / $489.78	Professional		$75.86	$120.23	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $38.90 / $141.25	Professional	26	$25.12	$38.90	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $79.43 / $154.88	Professional	TC	$48.98	$79.43	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $107.15 / $223.87	Professional		$63.10	$107.15	$223.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $32.36 / $63.10	Professional	26	$20.89	$32.36	$63.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $75.86 / $158.49	Professional	TC	$41.69	$75.86	$158.49
HMSA Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $123.03 / $141.25	Professional		$45.71	$123.03	$141.25
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $38.90 / $39.81	Professional	26	$37.15	$38.90	$39.81
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $93.33 / $102.33	Professional	TC	$89.13	$93.33	$102.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $112.20 / $131.83	Professional		$104.71	$112.20	$131.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $33.88 / $38.90	Professional	26	$30.90	$33.88	$38.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $79.43 / $93.33	Professional	TC	$74.13	$79.43	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $177.83	Professional		$93.33	$125.89	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $37.15 / $56.23	Professional	26	$27.54	$37.15	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $89.13 / $123.03	Professional	TC	$63.10	$89.13	$123.03
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $138.04 / $213.80	Professional		$97.72	$138.04	$213.80
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $41.69 / $61.66	Professional	26	$27.54	$41.69	$61.66
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $97.72 / $154.88	Professional	TC	$66.07	$97.72	$154.88