Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $153.91 / $174.44 / $205.23	Facility		$153.91	$174.44	$205.23
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.29 / $88.72 / $104.38	Facility	26	$78.29	$88.72	$104.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $168.65 / $235.72 / $259.52	Professional		$168.65	$235.72	$259.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.86 / $56.99 / $235.09	Professional	26	$48.86	$56.99	$235.09
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $54.89 / $54.89 / $54.89	Professional	52	$54.89	$54.89	$54.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $126.48 / $162.66 / $202.54	Professional	TC	$126.48	$162.66	$202.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $167.76 / $167.76 / $167.76	Facility		$167.76	$167.76	$167.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.06 / $94.06 / $94.06	Facility	26	$94.06	$94.06	$94.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.09 / $339.88 / $711.87	Professional		$175.09	$339.88	$711.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.65 / $70.98 / $115.29	Professional	26	$58.65	$70.98	$115.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.09 / $276.42 / $640.89	Professional	TC	$94.09	$276.42	$640.89
HMSA Facility/Professional Professional Modifier Low / Median / High Price $94.49 / $747.14 / $7,137.00	Professional		$94.49	$747.14	$7,137.00
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $103.58 / $108.46 / $111.17	Professional	26	$103.58	$108.46	$111.17
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $639.74 / $669.88 / $671.17	Professional	TC	$639.74	$669.88	$671.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $167.22 / $182.42 / $212.83	Professional		$167.22	$182.42	$212.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $85.05 / $92.78 / $108.25	Professional	26	$85.05	$92.78	$108.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.17 / $89.64 / $94.87	Professional	TC	$82.17	$89.64	$94.87
United Facility/Professional Professional Modifier Low / Median / High Price $91.96 / $205.23 / $267.44	Professional		$91.96	$205.23	$267.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.40 / $104.38 / $132.71	Professional	26	$50.40	$104.38	$132.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.56 / $100.85 / $157.66	Professional	TC	$41.56	$100.85	$157.66
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $188.22 / $287.05 / $808.88	Professional		$188.22	$287.05	$808.88
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $61.43 / $101.19 / $175.84	Professional	26	$61.43	$101.19	$175.84
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $92.63 / $192.86 / $727.01	Professional	TC	$92.63	$192.86	$727.01