Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.68 / $58.30 / $353.83	Facility	26	$55.68	$58.30	$353.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $231.15 / $364.03 / $1,398.08	Professional		$231.15	$364.03	$1,398.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $61.07 / $217.79	Professional	26	$52.46	$61.07	$217.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $172.46 / $290.93 / $935.18	Professional	TC	$172.46	$290.93	$935.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.88 / $209.70 / $334.95	Professional		$204.88	$209.70	$334.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.21 / $43.28 / $61.59	Professional	26	$34.21	$43.28	$61.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $262.89 / $468.26 / $879.23	Professional		$262.89	$468.26	$879.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.69 / $77.89 / $151.91	Professional	26	$54.69	$77.89	$151.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $207.50 / $389.04 / $735.69	Professional	TC	$207.50	$389.04	$735.69
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $216.04 / $332.35 / $805.96	Professional		$216.04	$332.35	$805.96
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.11 / $73.79 / $177.64	Professional	26	$54.11	$73.79	$177.64
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $166.79 / $259.57 / $621.96	Professional	TC	$166.79	$259.57	$621.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $211.32 / $398.71 / $809.43	Professional		$211.32	$398.71	$809.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.97 / $70.70 / $161.35	Professional	26	$34.97	$70.70	$161.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $171.14 / $331.31 / $643.16	Professional	TC	$171.14	$331.31	$643.16
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $236.34 / $315.67 / $426.15	Professional		$236.34	$315.67	$426.15
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.99 / $63.85 / $86.20	Professional	26	$51.99	$63.85	$86.20
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $184.35 / $251.82 / $339.96	Professional	TC	$184.35	$251.82	$339.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $244.09 / $334.49 / $557.54	Professional		$244.09	$334.49	$557.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.48 / $76.62 / $124.51	Professional	26	$56.48	$76.62	$124.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $208.60 / $312.89 / $507.38	Professional	TC	$208.60	$312.89	$507.38
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $525.76 / $525.76 / $537.20	Facility	26	$525.76	$525.76	$537.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,195.67 / $2,261.56 / $2,261.56	Professional		$2,195.67	$2,261.56	$2,261.56
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $439.20 / $439.20 / $459.75	Professional	26	$439.20	$439.20	$459.75
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,890.23 / $1,946.93 / $1,946.93	Professional	TC	$1,890.23	$1,946.93	$1,946.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $189.99	Professional		$32.34	$32.34	$189.99
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $218.73 / $453.00 / $754.66	Professional		$218.73	$453.00	$754.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.70 / $69.61 / $156.13	Professional	26	$34.70	$69.61	$156.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $171.14 / $331.31 / $630.84	Professional	TC	$171.14	$331.31	$630.84
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $910.28 / $910.28 / $910.28	Professional		$910.28	$910.28	$910.28
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 $711.76 / $711.76 / $711.76	Professional	TC	$711.76	$711.76	$711.76
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $255.32 / $351.07 / $618.24	Professional		$255.32	$351.07	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $234.98 / $314.32 / $700.12	Professional		$234.98	$314.32	$700.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.29 / $65.08 / $162.35	Professional	26	$47.29	$65.08	$162.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.91 / $266.85 / $621.12	Professional	TC	$181.91	$266.85	$621.12