Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.95 / $69.08 / $471.21	Facility	26	$65.95	$69.08	$471.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $243.31 / $380.46 / $1,415.64	Professional		$243.31	$380.46	$1,415.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.17 / $80.97 / $258.95	Professional	26	$62.17	$80.97	$258.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $153.04 / $314.49 / $715.76	Professional	TC	$153.04	$314.49	$715.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $139.72 / $225.10 / $318.13	Professional		$139.72	$225.10	$318.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.40 / $71.88 / $182.01	Professional	26	$45.40	$71.88	$182.01
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $264.54 / $444.01 / $804.84	Professional		$264.54	$444.01	$804.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.91 / $93.14 / $181.42	Professional	26	$64.91	$93.14	$181.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.00 / $354.51 / $606.41	Professional	TC	$190.00	$354.51	$606.41
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $230.20 / $353.64 / $857.24	Professional		$230.20	$353.64	$857.24
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.45 / $87.82 / $215.48	Professional	26	$64.45	$87.82	$215.48
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $171.56 / $262.82 / $617.66	Professional	TC	$171.56	$262.82	$617.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.25 / $87.25 / $87.25	Facility	26	$87.25	$87.25	$87.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $200.02 / $377.48 / $743.22	Professional		$200.02	$377.48	$743.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.46 / $84.18 / $196.63	Professional	26	$42.46	$84.18	$196.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.35 / $281.60 / $558.60	Professional	TC	$141.35	$281.60	$558.60
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $214.84 / $288.27 / $389.16	Professional		$214.84	$288.27	$389.16
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.71 / $84.64 / $114.26	Professional	26	$53.71	$84.64	$114.26
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $161.13 / $203.62 / $274.89	Professional	TC	$161.13	$203.62	$274.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $212.59 / $290.44 / $486.30	Professional		$212.59	$290.44	$486.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.91 / $101.57 / $165.05	Professional	26	$74.91	$101.57	$165.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $156.97 / $235.47 / $381.82	Professional	TC	$156.97	$235.47	$381.82
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $697.76 / $697.76 / $714.16	Facility	26	$697.76	$697.76	$714.16
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,997.15 / $2,036.01 / $2,036.01	Professional		$1,997.15	$2,036.01	$2,036.01
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $484.69 / $484.69 / $610.73	Professional	26	$484.69	$484.69	$610.73
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,005.00 / $2,005.00 / $2,005.00	Professional	TC	$2,005.00	$2,005.00	$2,005.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $177.43	Professional		$32.34	$32.34	$177.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $87.25 / $87.25 / $87.25	Facility	26	$87.25	$87.25	$87.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $208.98 / $419.68 / $702.11	Professional		$208.98	$419.68	$702.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.80 / $83.55 / $193.83	Professional	26	$41.80	$83.55	$193.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $141.35 / $281.60 / $529.65	Professional	TC	$141.35	$281.60	$529.65
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $814.59 / $814.59 / $814.59	Professional		$814.59	$814.59	$814.59
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $264.56 / $264.56 / $264.56	Professional	26	$264.56	$264.56	$264.56
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $550.03 / $550.03 / $550.03	Professional	TC	$550.03	$550.03	$550.03
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $233.13 / $320.55 / $561.23	Professional		$233.13	$320.55	$561.23
United Facility/Professional Professional Modifier Low / Median / High Price $211.36 / $298.41 / $636.71	Professional		$211.36	$298.41	$636.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.15 / $82.80 / $189.04	Professional	26	$56.15	$82.80	$189.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.50 / $221.23 / $480.10	Professional	TC	$140.50	$221.23	$480.10