Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $794.40 / $848.45 / $861.36	Facility		$794.40	$848.45	$861.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.07 / $235.65 / $334.90	Professional		$169.07	$235.65	$334.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $39.19 / $133.63	Professional	26	$32.11	$39.19	$133.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.96 / $178.73 / $286.79	Professional	TC	$169.96	$178.73	$286.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $209.15 / $209.15 / $209.15	Facility		$209.15	$209.15	$209.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.51 / $37.51 / $37.51	Facility	26	$37.51	$37.51	$37.51
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $172.98 / $172.98 / $172.98	Facility	TC	$172.98	$172.98	$172.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $168.69 / $250.79 / $496.51	Professional		$168.69	$250.79	$496.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.65 / $39.19 / $72.98	Professional	26	$30.65	$39.19	$72.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $211.60 / $423.52	Professional	TC	$138.04	$211.60	$423.52
HMSA Facility/Professional Professional Modifier Low / Median / High Price $40.76 / $244.65 / $282.05	Professional		$40.76	$244.65	$282.05
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $45.71 / $46.85	Professional	26	$43.65	$45.71	$46.85
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $201.00 / $210.47 / $248.49	Professional	TC	$201.00	$210.47	$248.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $220.69 / $240.76 / $280.88	Professional		$220.69	$240.76	$280.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.49 / $37.61 / $43.89	Professional	26	$34.49	$37.61	$43.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $203.14 / $236.99	Professional	TC	$186.21	$203.14	$236.99
United Facility/Professional Professional Modifier Low / Median / High Price $15.00 / $250.79 / $333.85	Professional		$15.00	$250.79	$333.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.98 / $39.19 / $53.84	Professional	26	$31.98	$39.19	$53.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $152.35 / $211.60 / $280.01	Professional	TC	$152.35	$211.60	$280.01
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $186.32 / $239.01 / $520.40	Professional		$186.32	$239.01	$520.40
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $29.58 / $39.03 / $81.95	Professional	26	$29.58	$39.03	$81.95
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $156.74 / $199.98 / $438.45	Professional	TC	$156.74	$199.98	$438.45