Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $64.37 / $72.95 / $89.40	Facility		$64.37	$72.95	$89.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.37 / $18.55 / $22.74	Facility	26	$16.37	$18.55	$22.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.84 / $90.42 / $139.19	Professional		$74.84	$90.42	$139.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.72 / $16.73 / $28.46	Professional	26	$14.72	$16.73	$28.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.01 / $90.34 / $154.11	Professional	TC	$65.01	$90.34	$154.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.95 / $101.77 / $184.67	Professional		$72.95	$101.77	$184.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.55 / $22.78 / $23.21	Professional	26	$18.55	$22.78	$23.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.40 / $80.86 / $161.88	Professional	TC	$54.40	$80.86	$161.88
HMSA Facility/Professional Professional Modifier Low / Median / High Price $21.66 / $169.18 / $202.07	Professional		$21.66	$169.18	$202.07
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $23.20 / $24.29 / $24.90	Professional	26	$23.20	$24.29	$24.90
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $153.80 / $169.20 / $177.17	Professional	TC	$153.80	$169.20	$177.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $78.67 / $85.82 / $100.13	Professional		$78.67	$85.82	$100.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.01 / $21.83 / $25.47	Professional	26	$20.01	$21.83	$25.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $58.66 / $64.00 / $74.66	Professional	TC	$58.66	$64.00	$74.66
United Facility/Professional Professional Modifier Low / Median / High Price $67.70 / $84.81 / $113.27	Professional		$67.70	$84.81	$113.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.55 / $22.74 / $29.94	Professional	26	$18.55	$22.74	$29.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.69 / $60.90 / $83.33	Professional	TC	$48.69	$60.90	$83.33
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $52.36 / $85.27 / $196.38	Professional		$52.36	$85.27	$196.38
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $13.71 / $21.02 / $24.29	Professional	26	$13.71	$21.02	$24.29
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $38.65 / $55.64 / $175.35	Professional	TC	$38.65	$55.64	$175.35