Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $169.82 / $524.81	Facility	26	$87.10	$169.82	$524.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $478.63 / $1,737.80	Professional		$257.04	$478.63	$1,737.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $125.89 / $338.84	Professional	26	$81.28	$125.89	$338.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $338.84 / $776.25	Professional	TC	$169.82	$338.84	$776.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $229.09 / $331.13	Professional		$194.98	$229.09	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $147.91 / $416.87	Professional	26	$114.82	$147.91	$416.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $602.56 / $1,047.13	Professional		$371.54	$602.56	$1,047.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $112.20 / $245.47	Professional	26	$79.43	$112.20	$245.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $489.78 / $831.76	Professional	TC	$281.84	$489.78	$831.76
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $512.86 / $954.99	Professional		$363.08	$512.86	$954.99
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $144.54 / $263.03	Professional	26	$104.71	$144.54	$263.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $380.19 / $691.83	Professional	TC	$257.04	$380.19	$691.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $141.25	Facility	26	$20.89	$97.72	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $478.63 / $954.99	Professional		$263.03	$478.63	$954.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $107.15 / $213.80	Professional	26	$60.26	$107.15	$213.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $363.08 / $741.31	Professional	TC	$194.98	$363.08	$741.31
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $346.74 / $467.74	Professional		$275.42	$346.74	$467.74
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $95.50 / $128.82	Professional	26	$77.62	$95.50	$128.82
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $251.19 / $338.84	Professional	TC	$199.53	$251.19	$338.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $380.19 / $724.44	Professional		$295.12	$380.19	$724.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $109.65 / $177.83	Professional	26	$85.11	$109.65	$177.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $331.13 / $588.84	Professional	TC	$257.04	$331.13	$588.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $794.33 / $794.33 / $794.33	Facility	26	$794.33	$794.33	$794.33
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,162.28 / $3,162.28 / $3,162.28	Professional		$3,162.28	$3,162.28	$3,162.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $660.69 / $691.83 / $691.83	Professional	26	$660.69	$691.83	$691.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,691.53 / $2,691.53 / $2,691.53	Professional	TC	$2,691.53	$2,691.53	$2,691.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $102.33 / $363.08	Professional		$32.36	$102.33	$363.08
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $141.25	Facility	26	$20.89	$97.72	$141.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $512.86 / $870.96	Professional		$263.03	$512.86	$870.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $97.72 / $181.97	Professional	26	$54.95	$97.72	$181.97
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $338.84 / $691.83	Professional	TC	$186.21	$338.84	$691.83
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,071.52 / $1,071.52	Professional		$1,071.52	$1,071.52	$1,071.52
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $295.12 / $295.12 / $295.12	Professional	26	$295.12	$295.12	$295.12
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $776.25 / $776.25 / $776.25	Professional	TC	$776.25	$776.25	$776.25
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $363.08 / $467.74	Professional		$275.42	$363.08	$467.74
United Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $398.11 / $794.33	Professional		$281.84	$398.11	$794.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $89.13 / $186.21	Professional	26	$67.61	$89.13	$186.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $316.23 / $616.60	Professional	TC	$199.53	$316.23	$616.60