Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.54 / $39.09 / $168.75	Professional		$29.54	$39.09	$168.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.01 / $3.76 / $17.95	Professional	26	$3.01	$3.76	$17.95
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.51 / $14.19 / $30.28	Professional	52	$13.51	$14.19	$30.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.75 / $37.18 / $90.00	Professional	TC	$33.75	$37.18	$90.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.49 / $3.49 / $3.49	Facility	26	$3.49	$3.49	$3.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $21.12 / $31.18 / $121.77	Professional		$21.12	$31.18	$121.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.93 / $3.78 / $6.84	Professional	26	$2.93	$3.78	$6.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.19 / $27.41 / $117.43	Professional	TC	$18.19	$27.41	$117.43
HMSA Facility/Professional Professional Modifier Low / Median / High Price $4.95 / $45.56 / $62.18	Professional		$4.95	$45.56	$62.18
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $5.12 / $5.36 / $5.50	Professional	26	$5.12	$5.36	$5.50
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $40.31 / $42.21 / $42.21	Professional	TC	$40.31	$42.21	$42.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.43 / $29.93 / $34.92	Professional		$27.43	$29.93	$34.92
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $3.31 / $3.61 / $4.21	Professional	26	$3.31	$3.61	$4.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.12 / $26.32 / $30.70	Professional	TC	$24.12	$26.32	$30.70
United Facility/Professional Professional Modifier Low / Median / High Price $25.44 / $42.83 / $102.48	Professional		$25.44	$42.83	$102.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.07 / $3.93 / $5.05	Professional	26	$3.07	$3.93	$5.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.37 / $27.41 / $37.77	Professional	TC	$22.37	$27.41	$37.77
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $24.27 / $36.26 / $142.79	Professional		$24.27	$36.26	$142.79
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $2.86 / $4.18 / $6.70	Professional	26	$2.86	$4.18	$6.70
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $21.40 / $31.98 / $132.38	Professional	TC	$21.40	$31.98	$132.38