Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $50.00 / $50.00	Facility		$50.00	$50.00	$50.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.09 / $77.91 / $119.00	Professional		$47.09	$77.91	$119.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.29 / $37.86 / $95.44	Professional	26	$30.29	$37.86	$95.44
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $56.53 / $56.53 / $209.18	Professional	50	$56.53	$56.53	$209.18
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.38 / $30.38 / $46.09	Professional	52	$30.38	$30.38	$46.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.07 / $23.55 / $71.00	Professional	TC	$15.07	$23.55	$71.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.57 / $52.57 / $52.57	Facility		$52.57	$52.57	$52.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.14 / $78.95 / $172.57	Professional		$37.14	$78.95	$172.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.05 / $34.24 / $69.23	Professional	26	$24.05	$34.24	$69.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.08 / $37.97 / $116.86	Professional	TC	$13.08	$37.97	$116.86
HMSA Facility/Professional Professional Modifier Low / Median / High Price $34.08 / $103.17 / $125.13	Professional		$34.08	$103.17	$125.13
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $36.50 / $38.22 / $39.17	Professional	26	$36.50	$38.22	$39.17
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $83.00 / $86.91 / $86.91	Professional	TC	$83.00	$86.91	$86.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.36 / $59.30 / $69.19	Professional		$54.36	$59.30	$69.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.32 / $36.35 / $42.41	Professional	26	$33.32	$36.35	$42.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.05 / $22.97 / $26.80	Professional	TC	$21.05	$22.97	$26.80
United Facility/Professional Professional Modifier Low / Median / High Price $47.52 / $63.52 / $104.42	Professional		$47.52	$63.52	$104.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.27 / $37.86 / $50.19	Professional	26	$26.27	$37.86	$50.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.67 / $24.25 / $54.23	Professional	TC	$22.67	$24.25	$54.23
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $48.73 / $79.36 / $98.98	Professional		$48.73	$79.36	$98.98
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $23.42 / $31.89 / $41.49	Professional	26	$23.42	$31.89	$41.49
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $25.31 / $41.21 / $67.04	Professional	TC	$25.31	$41.21	$67.04