Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $190.55 / $436.52	Facility	26	$141.25	$190.55	$436.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $501.19 / $1,819.70	Professional		$263.03	$501.19	$1,819.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $141.25 / $323.59	Professional	26	$70.79	$141.25	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $338.84 / $870.96	Professional	TC	$186.21	$338.84	$870.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $123.03 / $165.96	Professional	26	$123.03	$123.03	$165.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $691.83 / $1,174.90	Professional		$416.87	$691.83	$1,174.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $87.10 / $173.78	Professional	26	$64.57	$87.10	$173.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $602.56 / $977.24	Professional	TC	$316.23	$602.56	$977.24
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $691.83 / $1,230.27	Professional		$489.78	$691.83	$1,230.27
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $97.72 / $190.55	Professional	26	$69.18	$97.72	$190.55
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $602.56 / $1,071.52	Professional	TC	$416.87	$602.56	$1,071.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $81.28 / $114.82	Facility	26	$17.38	$81.28	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $512.86 / $954.99	Professional		$245.47	$512.86	$954.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $75.86 / $165.96	Professional	26	$44.67	$75.86	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $426.58 / $812.83	Professional	TC	$190.55	$426.58	$812.83
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $323.59 / $446.68	Professional		$239.88	$323.59	$446.68
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $79.43 / $107.15	Professional	26	$33.88	$79.43	$107.15
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $245.47 / $338.84	Professional	TC	$208.93	$245.47	$338.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $309.03 / $630.96	Professional		$239.88	$309.03	$630.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $91.20 / $154.88	Professional	26	$69.18	$91.20	$154.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $263.03 / $467.74	Professional	TC	$204.17	$263.03	$467.74
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	26	$645.65	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,884.03 / $2,884.03 / $3,090.30	Professional		$2,884.03	$2,884.03	$3,090.30
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $602.56 / $602.56 / $870.96	Professional	26	$602.56	$602.56	$870.96
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,570.40 / $2,570.40 / $2,818.38	Professional	TC	$2,570.40	$2,570.40	$2,818.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $85.11 / $363.08	Professional		$32.36	$85.11	$363.08
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $81.28 / $114.82	Facility	26	$17.38	$81.28	$114.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $512.86 / $870.96	Professional		$245.47	$512.86	$870.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $70.79 / $151.36	Professional	26	$38.90	$70.79	$151.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $426.58 / $812.83	Professional	TC	$181.97	$426.58	$812.83
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $912.01 / $912.01	Professional		$912.01	$912.01	$912.01
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $245.47 / $245.47	Professional	26	$245.47	$245.47	$245.47
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $676.08 / $676.08 / $676.08	Professional	TC	$676.08	$676.08	$676.08
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $316.23 / $407.38	Professional		$239.88	$316.23	$407.38
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $389.05 / $812.83	Professional		$239.88	$389.05	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $66.07 / $154.88	Professional	26	$46.77	$66.07	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $316.23 / $691.83	Professional	TC	$173.78	$316.23	$691.83