Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $72.44 / $169.82	Facility	26	$57.54	$72.44	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $331.13 / $1,122.02	Professional		$177.83	$331.13	$1,122.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $93.33 / $281.84	Professional	26	$56.23	$93.33	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $245.47 / $524.81	Professional	TC	$120.23	$245.47	$524.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $181.97 / $331.13	Professional		$109.65	$181.97	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $97.72 / $134.90	Professional	26	$28.18	$97.72	$134.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $436.52 / $724.44	Professional		$275.42	$436.52	$724.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $89.13 / $165.96	Professional	26	$64.57	$89.13	$165.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $346.74 / $549.54	Professional	TC	$194.98	$346.74	$549.54
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $323.59 / $588.84	Professional		$223.87	$323.59	$588.84
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $102.33 / $186.21	Professional	26	$74.13	$102.33	$186.21
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $223.87 / $416.87	Professional	TC	$151.36	$223.87	$416.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $97.72	Facility	26	$14.79	$69.18	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $309.03 / $562.34	Professional		$162.18	$309.03	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $75.86 / $147.91	Professional	26	$42.66	$75.86	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $223.87 / $426.58	Professional	TC	$109.65	$223.87	$426.58
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $229.09 / $309.03	Professional		$169.82	$229.09	$309.03
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $67.61 / $91.20	Professional	26	$53.70	$67.61	$91.20
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $162.18 / $218.78	Professional	TC	$114.82	$162.18	$218.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $223.87 / $407.38	Professional		$165.96	$223.87	$407.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $125.89	Professional	26	$57.54	$77.62	$125.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $173.78 / $302.00	Professional	TC	$131.83	$173.78	$302.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $549.54 / $549.54 / $549.54	Facility	26	$549.54	$549.54	$549.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Professional		$1,949.84	$1,949.84	$1,949.84
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $478.63 / $478.63	Professional	26	$436.52	$478.63	$478.63
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,621.81 / $1,621.81 / $1,621.81	Professional	TC	$1,621.81	$1,621.81	$1,621.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $72.44 / $204.17	Professional		$32.36	$72.44	$204.17
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $97.72	Facility	26	$14.79	$69.18	$97.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $331.13 / $524.81	Professional		$162.18	$331.13	$524.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $70.79 / $138.04	Professional	26	$37.15	$70.79	$138.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $223.87 / $426.58	Professional	TC	$97.72	$223.87	$426.58
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $630.96 / $630.96	Professional		$630.96	$630.96	$630.96
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Professional	26	$208.93	$208.93	$208.93
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $426.58 / $426.58	Professional	TC	$426.58	$426.58	$426.58
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $257.04 / $562.34	Professional		$186.21	$257.04	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $229.09 / $489.78	Professional		$165.96	$229.09	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $128.82	Professional	26	$46.77	$61.66	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $169.82 / $371.54	Professional	TC	$109.65	$169.82	$371.54