Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.34 / $66.01 / $399.89	Facility	26	$59.34	$66.01	$399.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $207.11 / $389.06 / $1,310.38	Professional		$207.11	$389.06	$1,310.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.34 / $69.23 / $274.08	Professional	26	$59.34	$69.23	$274.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.12 / $326.12 / $734.92	Professional	TC	$144.12	$326.12	$734.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $103.68 / $178.50 / $211.96	Professional		$103.68	$178.50	$211.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.62 / $63.26 / $289.95	Professional	26	$43.62	$63.26	$289.95
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.48 / $109.48 / $109.48	Professional	TC	$109.48	$109.48	$109.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $258.64 / $468.31 / $857.73	Professional		$258.64	$468.31	$857.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.23 / $88.69 / $172.54	Professional	26	$61.23	$88.69	$172.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $189.42 / $384.39 / $689.22	Professional	TC	$189.42	$384.39	$689.22
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $227.91 / $346.82 / $824.50	Professional		$227.91	$346.82	$824.50
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $61.26 / $83.53 / $196.57	Professional	26	$61.26	$83.53	$196.57
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $172.17 / $263.74 / $617.66	Professional	TC	$172.17	$263.74	$617.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.54 / $67.54 / $67.54	Facility	26	$67.54	$67.54	$67.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.15 / $389.97 / $756.08	Professional		$190.15	$389.97	$756.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.51 / $77.40 / $173.22	Professional	26	$39.51	$77.40	$173.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $140.82 / $292.04 / $593.08	Professional	TC	$140.82	$292.04	$593.08
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $191.61 / $258.12 / $348.46	Professional		$191.61	$258.12	$348.46
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.99 / $65.51 / $88.44	Professional	26	$45.99	$65.51	$88.44
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $145.62 / $192.61 / $260.02	Professional	TC	$145.62	$192.61	$260.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $195.08 / $260.11 / $426.16	Professional		$195.08	$260.11	$426.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.00 / $78.61 / $127.74	Professional	26	$58.00	$78.61	$127.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $148.50 / $222.75 / $361.19	Professional	TC	$148.50	$222.75	$361.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $540.48 / $540.48 / $553.04	Facility	26	$540.48	$540.48	$553.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,319.03 / $2,388.60 / $2,388.60	Professional		$2,319.03	$2,388.60	$2,388.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $543.21 / $543.21 / $543.21	Professional	26	$543.21	$543.21	$543.21
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,973.17 / $2,032.36 / $2,032.36	Professional	TC	$1,973.17	$2,032.36	$2,032.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $178.05	Professional		$32.34	$32.34	$178.05
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $67.54 / $67.54 / $67.54	Facility	26	$67.54	$67.54	$67.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $198.91 / $415.00 / $677.08	Professional		$198.91	$415.00	$677.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.29 / $76.81 / $169.97	Professional	26	$39.29	$76.81	$169.97
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $140.82 / $292.63 / $571.78	Professional	TC	$140.82	$292.63	$571.78
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $774.19 / $774.19 / $774.19	Professional		$774.19	$774.19	$774.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $224.16 / $224.16 / $224.16	Professional	26	$224.16	$224.16	$224.16
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 $208.75 / $287.02 / $618.24	Professional		$208.75	$287.02	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $200.32 / $306.37 / $692.50	Professional		$200.32	$306.37	$692.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.38 / $70.37 / $175.03	Professional	26	$53.38	$70.37	$175.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.51 / $231.74 / $497.75	Professional	TC	$140.51	$231.74	$497.75