Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,068.84 / $1,068.85 / $1,748.23	Professional		$1,068.84	$1,068.85	$1,748.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.29 / $310.50 / $1,205.85	Professional	26	$57.29	$310.50	$1,205.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $779.44 / $779.44 / $1,333.58	Professional	TC	$779.44	$779.44	$1,333.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,217.31 / $1,323.39 / $2,007.36	Professional		$1,217.31	$1,323.39	$2,007.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $340.14 / $381.98 / $511.46	Professional	26	$340.14	$381.98	$511.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $835.33 / $983.25 / $1,495.90	Professional	TC	$835.33	$983.25	$1,495.90
HMSA Facility/Professional Professional Modifier Low / Median / High Price $394.35 / $449.57 / $13,672.00	Professional		$394.35	$449.57	$13,672.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,164.58 / $1,270.45 / $1,482.19	Professional		$1,164.58	$1,270.45	$1,482.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $299.32 / $326.52 / $380.95	Professional	26	$299.32	$326.52	$380.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $865.26 / $943.92 / $1,101.24	Professional	TC	$865.26	$943.92	$1,101.24
United Facility/Professional Professional Modifier Low / Median / High Price $1,079.88 / $1,323.39 / $1,812.21	Professional		$1,079.88	$1,323.39	$1,812.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $277.55 / $340.14 / $460.41	Professional	26	$277.55	$340.14	$460.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $802.33 / $983.25 / $1,351.80	Professional	TC	$802.33	$983.25	$1,351.80
University Health Alliance Facility/Professional Professional Modifier Low / Median / High Price $1,225.83 / $10,928.00 / $18,532.00	Professional		$1,225.83	$10,928.00	$18,532.00
University Health Alliance Facility/Professional Professional Modifier 26 Low / Median / High Price $208.50 / $339.56 / $782.53	Professional	26	$208.50	$339.56	$782.53
University Health Alliance Facility/Professional Professional Modifier TC Low / Median / High Price $650.11 / $1,028.30 / $2,185.06	Professional	TC	$650.11	$1,028.30	$2,185.06