Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $151.36 / $354.81	Facility	26	$141.25	$151.36	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $478.63 / $1,148.15	Professional		$245.47	$478.63	$1,148.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $125.89 / $323.59	Professional	26	$57.54	$125.89	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $338.84 / $812.83	Professional	TC	$186.21	$338.84	$812.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $128.82 / $128.82	Professional	26	$128.82	$128.82	$128.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $676.08 / $1,122.02	Professional		$398.11	$676.08	$1,122.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $83.18 / $165.96	Professional	26	$58.88	$83.18	$165.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $588.84 / $933.25	Professional	TC	$309.03	$588.84	$933.25
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $645.65 / $1,148.15	Professional		$457.09	$645.65	$1,148.15
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $95.50 / $173.78	Professional	26	$69.18	$95.50	$173.78
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $549.54 / $977.24	Professional	TC	$389.05	$549.54	$977.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $64.57 / $91.20	Facility	26	$13.80	$64.57	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $489.78 / $912.01	Professional		$223.87	$489.78	$912.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $72.44 / $144.54	Professional	26	$39.81	$72.44	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $407.38 / $776.25	Professional	TC	$177.83	$407.38	$776.25
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $302.00 / $407.38	Professional		$223.87	$302.00	$407.38
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $63.10 / $85.11	Professional	26	$30.90	$63.10	$85.11
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $239.88 / $323.59	Professional	TC	$190.55	$239.88	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $288.40 / $588.84	Professional		$223.87	$288.40	$588.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $72.44 / $123.03	Professional	26	$54.95	$72.44	$123.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $251.19 / $457.09	Professional	TC	$199.53	$251.19	$457.09
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $512.86 / $512.86 / $512.86	Facility	26	$512.86	$512.86	$512.86
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,884.03 / $2,884.03 / $2,951.21	Professional		$2,884.03	$2,884.03	$2,951.21
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $602.56 / $602.56 / $602.56	Professional	26	$602.56	$602.56	$602.56
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,570.40 / $2,570.40 / $2,691.53	Professional	TC	$2,570.40	$2,570.40	$2,691.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $67.61 / $338.84	Professional		$32.36	$67.61	$338.84
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $64.57 / $91.20	Facility	26	$13.80	$64.57	$91.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $489.78 / $831.76	Professional		$229.09	$489.78	$831.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $67.61 / $134.90	Professional	26	$34.67	$67.61	$134.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $407.38 / $776.25	Professional	TC	$177.83	$407.38	$776.25
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $851.14 / $851.14	Professional		$851.14	$851.14	$851.14
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $194.98 / $194.98	Professional	26	$194.98	$194.98	$194.98
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $660.69 / $660.69	Professional	TC	$660.69	$660.69	$660.69
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $288.40 / $380.19	Professional		$223.87	$288.40	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $380.19 / $776.25	Professional		$218.78	$380.19	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $57.54 / $123.03	Professional	26	$43.65	$57.54	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $302.00 / $660.69	Professional	TC	$169.82	$302.00	$660.69