Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $94.19 / $134.19 / $517.29	Facility		$94.19	$134.19	$517.29
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.77 / $31.48 / $37.03	Facility	26	$27.77	$31.48	$37.03
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $75.26 / $327.00 / $467.10	Facility	TC	$75.26	$327.00	$467.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.91 / $96.70 / $570.00	Professional		$57.91	$96.70	$570.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.04 / $46.78 / $154.33	Professional	26	$28.04	$46.78	$154.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.91 / $87.65 / $111.15	Professional	TC	$63.91	$87.65	$111.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.31 / $97.31 / $97.31	Facility		$97.31	$97.31	$97.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.67 / $31.67 / $31.67	Facility	26	$31.67	$31.67	$31.67
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $66.73 / $66.73 / $66.73	Facility	TC	$66.73	$66.73	$66.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.51 / $114.18 / $223.58	Professional		$67.51	$114.18	$223.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.23 / $35.07 / $63.30	Professional	26	$22.23	$35.07	$63.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.28 / $79.40 / $160.28	Professional	TC	$45.28	$79.40	$160.28
HMSA Facility/Professional Professional Modifier Low / Median / High Price $33.63 / $109.94 / $135.71	Professional		$33.63	$109.94	$135.71
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $36.86 / $38.60 / $39.56	Professional	26	$36.86	$38.60	$39.56
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $89.62 / $93.84 / $102.54	Professional	TC	$89.62	$93.84	$102.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $111.64 / $130.24	Professional		$102.33	$111.64	$130.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.17 / $32.92 / $38.40	Professional	26	$30.17	$32.92	$38.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.15 / $78.70 / $91.83	Professional	TC	$72.15	$78.70	$91.83
United Facility/Professional Professional Modifier Low / Median / High Price $92.75 / $125.59 / $153.68	Professional		$92.75	$125.59	$153.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.95 / $46.19 / $87.90	Professional	26	$29.95	$46.19	$87.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.80 / $88.55 / $107.49	Professional	TC	$62.80	$88.55	$107.49
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $85.77 / $137.38 / $207.66	Professional		$85.77	$137.38	$207.66
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $25.38 / $42.11 / $62.00	Professional	26	$25.38	$42.11	$62.00
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $60.38 / $99.86 / $150.65	Professional	TC	$60.38	$99.86	$150.65