Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $81.28 / $158.49	Facility	26	$58.88	$81.28	$158.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $371.54 / $1,174.90	Professional		$186.21	$371.54	$1,174.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $93.33 / $251.19	Professional	26	$53.70	$93.33	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $275.42 / $776.25	Professional	TC	$128.82	$275.42	$776.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $331.13	Professional		$302.00	$302.00	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $79.43 / $120.23	Professional	26	$50.12	$79.43	$120.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $436.52 / $812.83	Professional		$288.40	$436.52	$812.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $95.50 / $173.78	Professional	26	$63.10	$95.50	$173.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $338.84 / $630.96	Professional	TC	$218.78	$338.84	$630.96
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $467.74 / $812.83	Professional		$323.59	$467.74	$812.83
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $109.65 / $194.98	Professional	26	$79.43	$109.65	$194.98
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $354.81 / $630.96	Professional	TC	$245.47	$354.81	$630.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $60.26 / $87.10	Facility	26	$13.18	$60.26	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $331.13 / $616.60	Professional		$186.21	$331.13	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $75.86 / $147.91	Professional	26	$39.81	$75.86	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $251.19 / $478.63	Professional	TC	$138.04	$251.19	$478.63
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $239.88 / $323.59	Professional		$173.78	$239.88	$323.59
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $60.26 / $81.28	Professional	26	$41.69	$60.26	$81.28
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $177.83 / $239.88	Professional	TC	$131.83	$177.83	$239.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $234.42 / $467.74	Professional		$173.78	$234.42	$467.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $69.18 / $112.20	Professional	26	$52.48	$69.18	$112.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $194.98 / $338.84	Professional	TC	$151.36	$194.98	$338.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $489.78 / $489.78 / $489.78	Facility	26	$489.78	$489.78	$489.78
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,949.84	Professional		$1,659.59	$1,659.59	$1,949.84
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $426.58 / $426.58 / $562.34	Professional	26	$426.58	$426.58	$562.34
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,348.96 / $1,348.96 / $1,548.82	Professional	TC	$1,348.96	$1,348.96	$1,548.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $69.18 / $245.47	Professional		$32.36	$69.18	$245.47
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $60.26 / $87.10	Facility	26	$13.18	$60.26	$87.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $354.81 / $575.44	Professional		$186.21	$354.81	$575.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $70.79 / $125.89	Professional	26	$38.02	$70.79	$125.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $245.47 / $467.74	Professional	TC	$131.83	$245.47	$467.74
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $741.31 / $741.31	Professional		$741.31	$741.31	$741.31
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	26	$181.97	$181.97	$181.97
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $562.34 / $562.34	Professional	TC	$562.34	$562.34	$562.34
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $269.15 / $562.34	Professional		$194.98	$269.15	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $269.15 / $524.81	Professional		$194.98	$269.15	$524.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $58.88 / $123.03	Professional	26	$48.98	$58.88	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $213.80 / $426.58	Professional	TC	$144.54	$213.80	$426.58