Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $107.15 / $354.81	Facility	26	$56.23	$107.15	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $316.23 / $1,096.48	Professional		$173.78	$316.23	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $251.19	Professional	26	$54.95	$83.18	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $239.88 / $549.54	Professional	TC	$120.23	$239.88	$549.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $91.20 / $123.03	Professional	26	$27.54	$91.20	$123.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $436.52 / $741.31	Professional		$269.15	$436.52	$741.31
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $85.11 / $158.49	Professional	26	$60.26	$85.11	$158.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $346.74 / $588.84	Professional	TC	$199.53	$346.74	$588.84
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $389.05 / $707.95	Professional		$269.15	$389.05	$707.95
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $97.72 / $173.78	Professional	26	$70.79	$97.72	$173.78
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $288.40 / $512.86	Professional	TC	$199.53	$288.40	$512.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $93.33	Facility	26	$14.13	$66.07	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $323.59 / $588.84	Professional		$165.96	$323.59	$588.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $70.79 / $141.25	Professional	26	$40.74	$70.79	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $239.88 / $457.09	Professional	TC	$114.82	$239.88	$457.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $223.87 / $302.00	Professional		$162.18	$223.87	$302.00
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $64.57 / $87.10	Professional	26	$40.74	$64.57	$87.10
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $158.49 / $213.80	Professional	TC	$123.03	$158.49	$213.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $218.78 / $426.58	Professional		$162.18	$218.78	$426.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $120.23	Professional	26	$57.54	$74.13	$120.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $173.78 / $295.12	Professional	TC	$131.83	$173.78	$295.12
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $524.81 / $524.81 / $524.81	Facility	26	$524.81	$524.81	$524.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Professional		$1,949.84	$1,949.84	$1,949.84
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $457.09 / $457.09	Professional	26	$436.52	$457.09	$457.09
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,905.46 / $1,905.46 / $1,905.46	Professional	TC	$1,905.46	$1,905.46	$1,905.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $69.18 / $213.80	Professional		$32.36	$69.18	$213.80
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $93.33	Facility	26	$14.13	$66.07	$93.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $338.84 / $524.81	Professional		$165.96	$338.84	$524.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $69.18 / $123.03	Professional	26	$35.48	$69.18	$123.03
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $229.09 / $436.52	Professional	TC	$114.82	$229.09	$436.52
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $645.65 / $645.65	Professional		$645.65	$645.65	$645.65
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $199.53 / $199.53	Professional	26	$199.53	$199.53	$199.53
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $457.09 / $457.09	Professional	TC	$457.09	$457.09	$457.09
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $251.19 / $616.60	Professional		$181.97	$251.19	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $251.19 / $501.19	Professional		$169.82	$251.19	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.88 / $125.89	Professional	26	$44.67	$58.88	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $181.97 / $389.05	Professional	TC	$114.82	$181.97	$389.05