Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $124.91 / $149.88 / $526.40	Facility		$124.91	$149.88	$526.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.52 / $30.05 / $35.36	Facility	26	$26.52	$30.05	$35.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.87 / $166.55 / $205.32	Professional		$72.87	$166.55	$205.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.28 / $36.89 / $37.92	Professional	26	$25.28	$36.89	$37.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.04 / $49.89 / $91.78	Professional	TC	$44.04	$49.89	$91.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.96 / $166.55 / $166.55	Professional		$83.96	$166.55	$166.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.26 / $35.36 / $39.03	Professional	26	$24.26	$35.36	$39.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.87 / $131.21 / $131.21	Professional	TC	$54.87	$131.21	$131.21
HMSA Facility/Professional Professional Modifier Low / Median / High Price $31.47 / $95.15 / $2,278.00	Professional		$31.47	$95.15	$2,278.00
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $33.70 / $35.29 / $36.17	Professional	26	$33.70	$35.29	$36.17
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $129.61 / $149.05 / $156.07	Professional	TC	$129.61	$149.05	$156.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $135.71 / $148.04 / $172.72	Professional		$135.71	$148.04	$172.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.81 / $31.43 / $36.67	Professional	26	$28.81	$31.43	$36.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $106.91 / $116.63 / $136.07	Professional	TC	$106.91	$116.63	$136.07
United Facility/Professional Professional Modifier Low / Median / High Price $121.10 / $166.55 / $183.77	Professional		$121.10	$166.55	$183.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.05 / $35.36 / $44.09	Professional	26	$30.05	$35.36	$44.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.69 / $131.21 / $139.68	Professional	TC	$88.69	$131.21	$139.68
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $94.47 / $159.26 / $244.67	Professional		$94.47	$159.26	$244.67
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $29.97 / $39.78 / $67.67	Professional	26	$29.97	$39.78	$67.67
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $63.89 / $121.07 / $177.01	Professional	TC	$63.89	$121.07	$177.01