Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $131.83 / $407.38	Facility		$93.33	$131.83	$407.38
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $39.81 / $46.77	Facility	26	$34.67	$39.81	$46.77
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $81.28 / $97.72 / $117.49	Facility	TC	$81.28	$97.72	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $147.91 / $602.56	Professional		$95.50	$147.91	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $48.98 / $169.82	Professional	26	$31.62	$48.98	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $100.00 / $208.93	Professional	TC	$61.66	$100.00	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $134.90 / $275.42	Professional		$77.62	$134.90	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $40.74 / $79.43	Professional	26	$26.30	$40.74	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $97.72 / $199.53	Professional	TC	$51.29	$97.72	$199.53
HMSA Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $151.36 / $173.78	Professional		$57.54	$151.36	$173.78
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $47.86 / $48.98	Professional	26	$45.71	$47.86	$48.98
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $112.20 / $123.03	Professional	TC	$107.15	$112.20	$123.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $141.25 / $162.18	Professional		$128.82	$141.25	$162.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $41.69 / $48.98	Professional	26	$38.02	$41.69	$48.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $97.72 / $114.82	Professional	TC	$91.20	$97.72	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $154.88 / $223.87	Professional		$114.82	$154.88	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $45.71 / $70.79	Professional	26	$34.67	$45.71	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $109.65 / $151.36	Professional	TC	$77.62	$109.65	$151.36
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $173.78 / $275.42	Professional		$144.54	$173.78	$275.42
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $52.48 / $77.62	Professional	26	$39.81	$52.48	$77.62
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $123.03 / $204.17	Professional	TC	$100.00	$123.03	$204.17