Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.60 / $41.60 / $41.60	Facility		$41.60	$41.60	$41.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.16 / $40.89 / $85.00	Professional		$8.16	$40.89	$85.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $24.51 / $61.08	Professional	26	$22.01	$24.51	$61.08
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $281.35	Professional	50	$234.74	$234.74	$281.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.14 / $14.14 / $14.14	Professional	52	$14.14	$14.14	$14.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.42 / $55.64 / $115.00	Professional	TC	$18.42	$55.64	$115.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.38 / $41.38 / $41.38	Facility		$41.38	$41.38	$41.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.35 / $23.35 / $23.35	Facility	26	$23.35	$23.35	$23.35
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $18.64 / $18.64 / $18.64	Facility	TC	$18.64	$18.64	$18.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.54 / $77.87 / $94.41	Professional		$43.54	$77.87	$94.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.96 / $25.94 / $31.56	Professional	26	$20.96	$25.94	$31.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.35 / $51.94 / $65.73	Professional	TC	$20.35	$51.94	$65.73
HMSA Facility/Professional Professional Modifier Low / Median / High Price $27.05 / $83.65 / $101.52	Professional		$27.05	$83.65	$101.52
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $29.65 / $31.05 / $31.82	Professional	26	$29.65	$31.05	$31.82
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $67.30 / $70.47 / $70.84	Professional	TC	$67.30	$70.47	$70.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.43 / $46.28 / $54.00	Professional		$42.43	$46.28	$54.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.61 / $24.66 / $28.77	Professional	26	$22.61	$24.66	$28.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.82 / $21.62 / $25.23	Professional	TC	$19.82	$21.62	$25.23
United Facility/Professional Professional Modifier Low / Median / High Price $36.04 / $48.40 / $89.67	Professional		$36.04	$48.40	$89.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.85 / $25.69 / $34.52	Professional	26	$17.85	$25.69	$34.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.19 / $23.74 / $62.08	Professional	TC	$18.19	$23.74	$62.08
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $35.06 / $57.09 / $92.33	Professional		$35.06	$57.09	$92.33
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $16.11 / $25.88 / $28.53	Professional	26	$16.11	$25.88	$28.53
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $18.95 / $30.86 / $66.45	Professional	TC	$18.95	$30.86	$66.45