Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.19 / $560.88 / $620.00	Facility		$128.19	$560.88	$620.00
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $324.30 / $324.30 / $324.30	Facility	TC	$324.30	$324.30	$324.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.73 / $141.85 / $399.08	Professional		$23.73	$141.85	$399.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.17 / $25.38 / $87.66	Professional	26	$21.17	$25.38	$87.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.24 / $116.91 / $183.21	Professional	TC	$104.24	$116.91	$183.21
Cigna Facility/Professional Facility Modifier Low / Median / High Price $133.10 / $133.10 / $133.10	Facility		$133.10	$133.10	$133.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.98 / $23.98 / $23.98	Facility	26	$23.98	$23.98	$23.98
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $109.98 / $109.98 / $109.98	Facility	TC	$109.98	$109.98	$109.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.45 / $160.56 / $303.05	Professional		$107.45	$160.56	$303.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.70 / $25.38 / $47.16	Professional	26	$19.70	$25.38	$47.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.75 / $135.18 / $255.89	Professional	TC	$87.75	$135.18	$255.89
HMSA Facility/Professional Professional Modifier Low / Median / High Price $26.72 / $171.30 / $196.56	Professional		$26.72	$171.30	$196.56
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $28.35 / $29.69 / $30.43	Professional	26	$28.35	$29.69	$30.43
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $142.94 / $149.69 / $166.31	Professional	TC	$142.94	$149.69	$166.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.30 / $154.13 / $179.83	Professional		$141.30	$154.13	$179.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.33 / $24.36 / $28.42	Professional	26	$22.33	$24.36	$28.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $118.95 / $129.77 / $151.40	Professional	TC	$118.95	$129.77	$151.40
United Facility/Professional Professional Modifier Low / Median / High Price $110.22 / $160.56 / $208.60	Professional		$110.22	$160.56	$208.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.37 / $34.85 / $100.00	Professional	26	$21.37	$34.85	$100.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.90 / $135.18 / $761.00	Professional	TC	$87.90	$135.18	$761.00
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $118.12 / $152.26 / $318.80	Professional		$118.12	$152.26	$318.80
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $18.87 / $25.31 / $53.57	Professional	26	$18.87	$25.31	$53.57
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $99.25 / $126.55 / $265.24	Professional	TC	$99.25	$126.55	$265.24