Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $218.78 / $501.19	Facility	26	$141.25	$218.78	$501.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $512.86 / $2,041.74	Professional		$316.23	$512.86	$2,041.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $141.25 / $331.13	Professional	26	$81.28	$141.25	$331.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $338.84 / $954.99	Professional	TC	$229.09	$338.84	$954.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $630.96 / $630.96	Professional		$630.96	$630.96	$630.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	26	$181.97	$181.97	$181.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $758.58 / $1,318.26	Professional		$467.74	$758.58	$1,318.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $104.71 / $229.09	Professional	26	$75.86	$104.71	$229.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $660.69 / $1,071.52	Professional	TC	$363.08	$660.69	$1,071.52
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $776.25 / $1,380.38	Professional		$537.03	$776.25	$1,380.38
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $138.04 / $251.19	Professional	26	$100.00	$138.04	$251.19
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $630.96 / $1,122.02	Professional	TC	$436.52	$630.96	$1,122.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $588.84 / $1,096.48	Professional		$302.00	$588.84	$1,096.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $104.71 / $199.53	Professional	26	$57.54	$104.71	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $478.63 / $891.25	Professional	TC	$229.09	$478.63	$891.25
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $398.11 / $537.03	Professional		$302.00	$398.11	$537.03
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $91.20 / $123.03	Professional	26	$53.70	$91.20	$123.03
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $309.03 / $416.87	Professional	TC	$245.47	$309.03	$416.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $398.11 / $741.31	Professional		$295.12	$398.11	$741.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $109.65 / $199.53	Professional	26	$81.28	$109.65	$199.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $354.81 / $602.56	Professional	TC	$263.03	$354.81	$602.56
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $741.31 / $741.31 / $741.31	Facility	26	$741.31	$741.31	$741.31
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,467.37 / $3,467.37 / $3,467.37	Professional		$3,467.37	$3,467.37	$3,467.37
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $660.69 / $660.69 / $660.69	Professional	26	$660.69	$660.69	$660.69
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,019.95 / $3,019.95 / $3,090.30	Professional	TC	$3,019.95	$3,019.95	$3,090.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $97.72 / $416.87	Professional		$32.36	$97.72	$416.87
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $602.56 / $977.24	Professional		$302.00	$602.56	$977.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $97.72 / $177.83	Professional	26	$50.12	$97.72	$177.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $457.09 / $870.96	Professional	TC	$229.09	$457.09	$870.96
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Professional		$1,174.90	$1,174.90	$1,174.90
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $281.84 / $281.84 / $281.84	Professional	26	$281.84	$281.84	$281.84
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $891.25 / $891.25 / $891.25	Professional	TC	$891.25	$891.25	$891.25
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $389.05 / $512.86	Professional		$302.00	$389.05	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $457.09 / $912.01	Professional		$302.00	$457.09	$912.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $83.18 / $177.83	Professional	26	$64.57	$83.18	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $380.19 / $776.25	Professional	TC	$229.09	$380.19	$776.25