Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $102.33 / $338.84	Facility	26	$52.48	$102.33	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $281.84 / $1,071.52	Professional		$123.03	$281.84	$1,071.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $83.18 / $213.80	Professional	26	$51.29	$83.18	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $251.19 / $630.96	Professional	TC	$147.91	$251.19	$630.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $269.15 / $467.74	Professional		$177.83	$269.15	$467.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $89.13 / $125.89	Professional	26	$51.29	$89.13	$125.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $398.11 / $724.44	Professional		$263.03	$398.11	$724.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $81.28 / $147.91	Professional	26	$57.54	$81.28	$147.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $323.59 / $562.34	Professional	TC	$208.93	$323.59	$562.34
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $380.19 / $707.95	Professional		$263.03	$380.19	$707.95
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $93.33 / $169.82	Professional	26	$67.61	$93.33	$169.82
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $288.40 / $537.03	Professional	TC	$194.98	$288.40	$537.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $309.03 / $602.56	Professional		$165.96	$309.03	$602.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $69.18 / $134.90	Professional	26	$38.90	$69.18	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $234.42 / $467.74	Professional	TC	$134.90	$234.42	$467.74
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $269.15 / $363.08	Professional		$194.98	$269.15	$363.08
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $61.66 / $83.18	Professional	26	$48.98	$61.66	$83.18
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $204.17 / $275.42	Professional	TC	$147.91	$204.17	$275.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $257.04 / $478.63	Professional		$194.98	$257.04	$478.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $114.82	Professional	26	$53.70	$70.79	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $223.87 / $389.05	Professional	TC	$173.78	$223.87	$389.05
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $501.19 / $501.19 / $501.19	Facility	26	$501.19	$501.19	$501.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,698.24 / $1,698.24	Professional		$1,659.59	$1,698.24	$1,698.24
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $346.74 / $436.52 / $436.52	Professional	26	$346.74	$436.52	$436.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,348.96 / $1,348.96 / $1,380.38	Professional	TC	$1,348.96	$1,348.96	$1,380.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $66.07 / $234.42	Professional		$32.36	$66.07	$234.42
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $331.13 / $562.34	Professional		$169.82	$331.13	$562.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $66.07 / $120.23	Professional	26	$33.88	$66.07	$120.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $229.09 / $446.68	Professional	TC	$125.89	$229.09	$446.68
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $741.31 / $741.31	Professional		$741.31	$741.31	$741.31
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Professional	26	$190.55	$190.55	$190.55
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $549.54 / $549.54	Professional	TC	$549.54	$549.54	$549.54
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $302.00 / $616.60	Professional		$218.78	$302.00	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $239.88 / $512.86	Professional		$190.55	$239.88	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $56.23 / $117.49	Professional	26	$42.66	$56.23	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $194.98 / $389.05	Professional	TC	$141.25	$194.98	$389.05