Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $181.97 / $269.15	Facility	26	$141.25	$181.97	$269.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $501.19 / $1,819.70	Professional		$213.80	$501.19	$1,819.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $144.54 / $371.54	Professional	26	$70.79	$144.54	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $338.84 / $870.96	Professional	TC	$147.91	$338.84	$870.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $199.53 / $380.19	Professional		$147.91	$199.53	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $112.20 / $162.18	Professional	26	$54.95	$112.20	$162.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $616.60 / $977.24	Professional		$346.74	$616.60	$977.24
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $109.65 / $204.17	Professional	26	$72.44	$109.65	$204.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $512.86 / $794.33	Professional	TC	$251.19	$512.86	$794.33
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $562.34 / $977.24	Professional		$398.11	$562.34	$977.24
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $114.82 / $213.80	Professional	26	$85.11	$114.82	$213.80
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $436.52 / $776.25	Professional	TC	$309.03	$436.52	$776.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $77.62 / $112.20	Facility	26	$16.98	$77.62	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $436.52 / $812.83	Professional		$199.53	$436.52	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $87.10 / $169.82	Professional	26	$48.98	$87.10	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $331.13 / $676.08	Professional	TC	$141.25	$331.13	$676.08
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $257.04 / $346.74	Professional		$190.55	$257.04	$346.74
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $75.86 / $102.33	Professional	26	$39.81	$75.86	$102.33
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $177.83 / $239.88	Professional	TC	$151.36	$177.83	$239.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $257.04 / $489.78	Professional		$190.55	$257.04	$489.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $91.20 / $169.82	Professional	26	$69.18	$91.20	$169.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $204.17 / $346.74	Professional	TC	$151.36	$204.17	$346.74
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $630.96 / $630.96 / $630.96	Facility	26	$630.96	$630.96	$630.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,884.03 / $2,884.03 / $2,884.03	Professional		$2,884.03	$2,884.03	$2,884.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $575.44 / $575.44 / $575.44	Professional	26	$575.44	$575.44	$575.44
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,511.89 / $2,511.89 / $2,511.89	Professional	TC	$2,511.89	$2,511.89	$2,511.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $83.18 / $309.03	Professional		$32.36	$83.18	$309.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $77.62 / $112.20	Facility	26	$16.98	$77.62	$112.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $436.52 / $758.58	Professional		$199.53	$436.52	$758.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $83.18 / $154.88	Professional	26	$41.69	$83.18	$154.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $331.13 / $660.69	Professional	TC	$131.83	$331.13	$660.69
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 $239.88 / $239.88 / $239.88	Professional	26	$239.88	$239.88	$239.88
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $512.86 / $512.86	Professional	TC	$512.86	$512.86	$512.86
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $288.40 / $1,380.38	Professional		$208.93	$288.40	$1,380.38
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $338.84 / $691.83	Professional		$194.98	$338.84	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $151.36	Professional	26	$53.70	$70.79	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $239.88 / $537.03	Professional	TC	$131.83	$239.88	$537.03