Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $432.75 / $490.45 / $577.00	Facility	26	$432.75	$490.45	$577.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,269.84 / $2,278.04 / $8,775.78	Professional		$1,269.84	$2,278.04	$8,775.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $347.37 / $585.52 / $1,492.99	Professional	26	$347.37	$585.52	$1,492.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,542.03 / $2,141.71 / $2,687.09	Professional	TC	$1,542.03	$2,141.71	$2,687.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,558.96 / $1,670.24 / $2,718.72	Professional		$1,558.96	$1,670.24	$2,718.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $322.64 / $442.47 / $577.00	Professional	26	$322.64	$442.47	$577.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,116.49 / $1,347.59 / $2,141.71	Professional	TC	$1,116.49	$1,347.59	$2,141.71
HMSA Facility/Professional Professional Modifier Low / Median / High Price $508.51 / $2,521.41 / $2,698.07	Professional		$508.51	$2,521.41	$2,698.07
HMSA Facility/Professional Professional Modifier 26 Low / Median / High Price $539.58 / $565.01 / $579.13	Professional	26	$539.58	$565.01	$579.13
HMSA Facility/Professional Professional Modifier TC Low / Median / High Price $2,002.81 / $2,097.17 / $2,246.07	Professional	TC	$2,002.81	$2,097.17	$2,246.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,074.29 / $2,416.64 / $2,819.42	Professional		$2,074.29	$2,416.64	$2,819.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $440.23 / $512.89 / $598.37	Professional	26	$440.23	$512.89	$598.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,634.05 / $1,903.75 / $1,983.08	Professional	TC	$1,634.05	$1,903.75	$1,983.08
United Facility/Professional Professional Modifier Low / Median / High Price $2,606.87 / $2,718.72 / $3,269.99	Professional		$2,606.87	$2,718.72	$3,269.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $494.17 / $577.00 / $675.27	Professional	26	$494.17	$577.00	$675.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $2,112.69 / $2,141.71 / $2,594.71	Professional	TC	$2,112.69	$2,141.71	$2,594.71
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $1,925.68 / $2,987.66 / $5,237.79	Professional		$1,925.68	$2,987.66	$5,237.79
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $432.21 / $631.38 / $1,010.16	Professional	26	$432.21	$631.38	$1,010.16
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $1,470.34 / $2,356.29 / $4,227.63	Professional	TC	$1,470.34	$2,356.29	$4,227.63