Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.75 / $39.35 / $160.00	Professional		$31.75	$39.35	$160.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.90 / $16.02 / $35.47	Professional	26	$12.90	$16.02	$35.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.58 / $23.76 / $37.39	Professional	TC	$21.58	$23.76	$37.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.90 / $11.90 / $11.90	Facility	26	$11.90	$11.90	$11.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.36 / $40.52 / $56.00	Professional		$35.36	$40.52	$56.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.68 / $16.63 / $21.55	Professional	26	$12.68	$16.63	$21.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.55 / $27.02 / $34.45	Professional	TC	$22.55	$27.02	$34.45
HMSA Facility/Professional Professional Modifier Low / Median / High Price $17.50 / $36.92 / $50.42	Professional		$17.50	$36.92	$50.42
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $19.32 / $20.12	Professional	26	$18.45	$19.32	$20.12
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $29.70 / $31.10 / $32.39	Professional	TC	$29.70	$31.10	$32.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.67 / $38.92 / $45.40	Professional		$35.67	$38.92	$45.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.35 / $12.38 / $14.45	Professional	26	$11.35	$12.38	$14.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.32 / $26.53 / $30.95	Professional	TC	$24.32	$26.53	$30.95
United Facility/Professional Professional Modifier Low / Median / High Price $34.07 / $40.54 / $62.48	Professional		$34.07	$40.54	$62.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.90 / $18.05 / $22.49	Professional	26	$12.90	$18.05	$22.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.59 / $27.64 / $39.99	Professional	TC	$20.59	$27.64	$39.99
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $29.16 / $47.48 / $159.94	Professional		$29.16	$47.48	$159.94
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $10.49 / $12.74 / $17.39	Professional	26	$10.49	$12.74	$17.39
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $18.66 / $22.66 / $30.93	Professional	TC	$18.66	$22.66	$30.93