Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.04 / $58.71 / $353.83	Facility	26	$56.04	$58.71	$353.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.58 / $315.56 / $1,031.96	Professional		$178.58	$315.56	$1,031.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $62.84 / $268.42	Professional	26	$52.78	$62.84	$268.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $259.52 / $600.44	Professional	TC	$119.70	$259.52	$600.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $245.36 / $245.36 / $245.36	Professional		$245.36	$245.36	$245.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.28 / $74.80 / $108.25	Professional	26	$43.28	$74.80	$108.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $237.09 / $382.43 / $711.97	Professional		$237.09	$382.43	$711.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.69 / $78.47 / $152.52	Professional	26	$54.69	$78.47	$152.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $171.42 / $309.69 / $571.65	Professional	TC	$171.42	$309.69	$571.65
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $189.17 / $289.33 / $683.70	Professional		$189.17	$289.33	$683.70
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.11 / $73.79 / $178.04	Professional	26	$54.11	$73.79	$178.04
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $139.91 / $214.36 / $509.67	Professional	TC	$139.91	$214.36	$509.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $65.98	Facility	26	$65.98	$65.98	$65.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $159.33 / $322.79 / $626.87	Professional		$159.33	$322.79	$626.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.09 / $70.50 / $161.72	Professional	26	$35.09	$70.50	$161.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.28 / $242.10 / $492.51	Professional	TC	$114.28	$242.10	$492.51
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $163.08 / $221.12 / $298.51	Professional		$163.08	$221.12	$298.51
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.77 / $63.85 / $86.20	Professional	26	$40.77	$63.85	$86.20
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $122.31 / $157.26 / $212.30	Professional	TC	$122.31	$157.26	$212.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $172.58 / $223.53 / $415.64	Professional		$172.58	$223.53	$415.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.48 / $76.62 / $133.77	Professional	26	$56.48	$76.62	$133.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $121.28 / $181.92 / $294.95	Professional	TC	$121.28	$181.92	$294.95
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $525.76 / $525.76 / $540.32	Facility	26	$525.76	$525.76	$540.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,882.38 / $1,938.85 / $1,938.85	Professional		$1,882.38	$1,938.85	$1,938.85
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $434.24 / $434.24 / $459.75	Professional	26	$434.24	$434.24	$459.75
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,906.00 / $1,906.00 / $1,906.00	Professional	TC	$1,906.00	$1,906.00	$1,906.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $151.38	Professional		$32.34	$32.34	$151.38
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $65.98	Facility	26	$65.98	$65.98	$65.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $167.54 / $350.11 / $561.26	Professional		$167.54	$350.11	$561.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.94 / $69.93 / $156.13	Professional	26	$34.94	$69.93	$156.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.28 / $248.27 / $464.06	Professional	TC	$114.28	$248.27	$464.06
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $652.37 / $652.37 / $652.37	Professional		$652.37	$652.37	$652.37
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $198.51 / $198.51 / $198.51	Professional	26	$198.51	$198.51	$198.51
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $453.85 / $453.85 / $453.85	Professional	TC	$453.85	$453.85	$453.85
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $178.82 / $245.88 / $618.24	Professional		$178.82	$245.88	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $169.02 / $250.99 / $563.66	Professional		$169.02	$250.99	$563.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.29 / $62.70 / $148.41	Professional	26	$47.29	$62.70	$148.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.95 / $188.98 / $439.52	Professional	TC	$115.95	$188.98	$439.52