Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.59 / $110.26 / $581.96	Facility	26	$89.59	$110.26	$581.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $364.63 / $457.47 / $1,921.88	Professional		$364.63	$457.47	$1,921.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.53 / $117.84 / $365.21	Professional	26	$84.53	$117.84	$365.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.14 / $358.02 / $1,372.00	Professional	TC	$263.14	$358.02	$1,372.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $285.83 / $346.88 / $609.32	Professional		$285.83	$346.88	$609.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.04 / $115.99 / $247.44	Professional	26	$72.04	$115.99	$247.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $464.60 / $464.60 / $518.10	Professional	TC	$464.60	$464.60	$518.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $370.67 / $553.53 / $1,091.61	Professional		$370.67	$553.53	$1,091.61
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $85.69 / $121.77 / $238.95	Professional	26	$85.69	$121.77	$238.95
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $274.69 / $426.38 / $811.92	Professional	TC	$274.69	$426.38	$811.92
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $291.86 / $447.84 / $1,104.21	Professional		$291.86	$447.84	$1,104.21
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $89.40 / $121.11 / $294.24	Professional	26	$89.40	$121.11	$294.24
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $210.56 / $327.74 / $816.68	Professional	TC	$210.56	$327.74	$816.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.46 / $108.46 / $108.46	Facility	26	$108.46	$108.46	$108.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $242.22 / $496.60 / $1,077.39	Professional		$242.22	$496.60	$1,077.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.91 / $116.92 / $267.22	Professional	26	$57.91	$116.92	$267.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.50 / $374.92 / $799.20	Professional	TC	$186.50	$374.92	$799.20
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $319.24 / $446.69 / $603.03	Professional		$319.24	$446.69	$603.03
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.19 / $105.23 / $142.06	Professional	26	$86.19	$105.23	$142.06
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $233.05 / $341.47 / $460.98	Professional	TC	$233.05	$341.47	$460.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $327.61 / $443.23 / $695.02	Professional		$327.61	$443.23	$695.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.19 / $126.28 / $205.20	Professional	26	$93.19	$126.28	$205.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $263.23 / $394.85 / $640.25	Professional	TC	$263.23	$394.85	$640.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $868.88 / $868.88 / $887.84	Facility	26	$868.88	$868.88	$887.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,326.86 / $2,326.86 / $2,876.93	Professional		$2,326.86	$2,326.86	$2,876.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $600.70 / $600.70 / $763.13	Professional	26	$600.70	$600.70	$763.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,909.00 / $2,909.00 / $2,909.00	Professional	TC	$2,909.00	$2,909.00	$2,909.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $287.41	Professional		$32.34	$32.34	$287.41
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $108.46 / $108.46 / $108.46	Facility	26	$108.46	$108.46	$108.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $280.00 / $578.04 / $1,007.78	Professional		$280.00	$578.04	$1,007.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.67 / $112.50 / $257.55	Professional	26	$55.67	$112.50	$257.55
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $417.40 / $417.40 / $417.40	Professional	52	$417.40	$417.40	$417.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $186.50 / $371.89 / $753.75	Professional	TC	$186.50	$371.89	$753.75
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,228.03 / $1,228.03 / $1,228.03	Professional		$1,228.03	$1,228.03	$1,228.03
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $326.32 / $326.32 / $326.32	Professional	26	$326.32	$326.32	$326.32
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $901.70 / $901.70 / $901.70	Professional	TC	$901.70	$901.70	$901.70
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $361.26 / $446.93 / $542.70	Professional		$361.26	$446.93	$542.70
United Facility/Professional Professional Modifier Low / Median / High Price $317.50 / $401.18 / $930.01	Professional		$317.50	$401.18	$930.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.13 / $106.56 / $252.61	Professional	26	$82.13	$106.56	$252.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $230.38 / $303.58 / $696.84	Professional	TC	$230.38	$303.58	$696.84