Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.24 / $87.04 / $518.22	Facility	26	$83.24	$87.04	$518.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $258.17 / $434.01 / $1,194.11	Professional		$258.17	$434.01	$1,194.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.66 / $90.18 / $326.13	Professional	26	$74.66	$90.18	$326.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.98 / $345.83 / $949.67	Professional	TC	$171.98	$345.83	$949.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $441.57 / $558.87 / $558.87	Professional		$441.57	$558.87	$558.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $189.86 / $189.86 / $189.86	Professional	26	$189.86	$189.86	$189.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $310.19 / $539.48 / $1,015.28	Professional		$310.19	$539.48	$1,015.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.79 / $104.65 / $213.57	Professional	26	$76.79	$104.65	$213.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $223.83 / $436.25 / $819.91	Professional	TC	$223.83	$436.25	$819.91
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $252.16 / $386.75 / $930.99	Professional		$252.16	$386.75	$930.99
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $80.06 / $108.75 / $258.39	Professional	26	$80.06	$108.75	$258.39
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $179.21 / $278.95 / $655.20	Professional	TC	$179.21	$278.95	$655.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.97 / $96.97 / $96.97	Facility	26	$96.97	$96.97	$96.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $255.01 / $475.02 / $977.21	Professional		$255.01	$475.02	$977.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.84 / $100.98 / $237.25	Professional	26	$51.84	$100.98	$237.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $184.82 / $363.23 / $761.52	Professional	TC	$184.82	$363.23	$761.52
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $274.89 / $345.41 / $466.30	Professional		$274.89	$345.41	$466.30
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.97 / $93.60 / $126.36	Professional	26	$76.97	$93.60	$126.36
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $197.92 / $251.82 / $339.96	Professional	TC	$197.92	$251.82	$339.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $294.95 / $399.05 / $752.12	Professional		$294.95	$399.05	$752.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.10 / $112.32 / $177.74	Professional	26	$83.10	$112.32	$177.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $237.77 / $356.66 / $578.34	Professional	TC	$237.77	$356.66	$578.34
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $776.08 / $776.08 / $792.40	Facility	26	$776.08	$776.08	$792.40
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,081.89 / $3,174.35 / $3,174.35	Professional		$3,081.89	$3,174.35	$3,174.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $554.78 / $554.78 / $683.18	Professional	26	$554.78	$554.78	$683.18
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,625.91 / $2,704.69 / $2,704.69	Professional	TC	$2,625.91	$2,704.69	$2,704.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $213.71	Professional		$32.34	$32.34	$213.71
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.97 / $96.97 / $96.97	Facility	26	$96.97	$96.97	$96.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $259.88 / $553.88 / $915.47	Professional		$259.88	$553.88	$915.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.81 / $96.43 / $220.83	Professional	26	$51.81	$96.43	$220.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $190.03 / $350.00 / $727.60	Professional	TC	$190.03	$350.00	$727.60
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,076.35 / $1,076.35 / $1,076.35	Professional		$1,076.35	$1,076.35	$1,076.35
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $291.26 / $291.26 / $291.26	Professional	26	$291.26	$291.26	$291.26
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $785.09 / $785.09 / $785.09	Professional	TC	$785.09	$785.09	$785.09
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $279.33 / $384.10 / $467.31	Professional		$279.33	$384.10	$467.31
United Facility/Professional Professional Modifier Low / Median / High Price $278.54 / $399.30 / $1,089.06	Professional		$278.54	$399.30	$1,089.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.77 / $91.67 / $225.62	Professional	26	$70.77	$91.67	$225.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $200.62 / $307.37 / $712.52	Professional	TC	$200.62	$307.37	$712.52