Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.16 / $81.05 / $503.28	Facility	26	$77.16	$81.05	$503.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $248.37 / $296.51 / $1,439.59	Professional		$248.37	$296.51	$1,439.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.00 / $87.17 / $402.00	Professional	26	$73.00	$87.17	$402.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.99 / $216.89 / $535.82	Professional	TC	$151.99	$216.89	$535.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $407.25 / $407.25 / $407.25	Professional		$407.25	$407.25	$407.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.33 / $154.44 / $202.40	Professional	26	$65.33	$154.44	$202.40
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $267.92 / $373.70 / $710.95	Professional		$267.92	$373.70	$710.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.52 / $103.10 / $199.03	Professional	26	$75.52	$103.10	$199.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $176.14 / $266.44 / $491.58	Professional	TC	$176.14	$266.44	$491.58
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $234.57 / $359.49 / $878.36	Professional		$234.57	$359.49	$878.36
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $76.92 / $104.19 / $249.37	Professional	26	$76.92	$104.19	$249.37
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $164.58 / $255.33 / $613.00	Professional	TC	$164.58	$255.33	$613.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.84 / $93.84 / $93.84	Facility	26	$93.84	$93.84	$93.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.65 / $323.13 / $765.42	Professional		$175.65	$323.13	$765.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.24 / $99.31 / $231.42	Professional	26	$48.24	$99.31	$231.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.64 / $223.34 / $539.03	Professional	TC	$117.64	$223.34	$539.03
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $218.16 / $296.66 / $400.49	Professional		$218.16	$296.66	$400.49
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.27 / $91.05 / $122.92	Professional	26	$63.27	$91.05	$122.92
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $205.60 / $277.56	Professional	TC	$154.88	$205.60	$277.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $230.52 / $296.47 / $544.42	Professional		$230.52	$296.47	$544.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.59 / $109.26 / $185.32	Professional	26	$80.59	$109.26	$185.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $158.58 / $237.87 / $385.69	Professional	TC	$158.58	$237.87	$385.69
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $750.32 / $750.32 / $768.32	Facility	26	$750.32	$750.32	$768.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,515.48 / $1,515.48 / $1,932.15	Professional		$1,515.48	$1,515.48	$1,932.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $521.79 / $521.79 / $655.65	Professional	26	$521.79	$521.79	$655.65
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $993.68 / $993.68 / $1,276.50	Professional	TC	$993.68	$993.68	$1,276.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $158.40	Professional		$32.34	$32.34	$158.40
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $93.84 / $93.84 / $93.84	Facility	26	$93.84	$93.84	$93.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $189.30 / $375.63 / $712.34	Professional		$189.30	$375.63	$712.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.34 / $95.83 / $229.82	Professional	26	$45.34	$95.83	$229.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $112.72 / $216.27 / $510.95	Professional	TC	$112.72	$216.27	$510.95
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $828.37 / $828.37 / $828.37	Professional		$828.37	$828.37	$828.37
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $282.50 / $282.50 / $282.50	Professional	26	$282.50	$282.50	$282.50
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $545.86 / $545.86 / $545.86	Professional	TC	$545.86	$545.86	$545.86
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $239.91 / $305.42 / $370.87	Professional		$239.91	$305.42	$370.87
United Facility/Professional Professional Modifier Low / Median / High Price $215.04 / $280.39 / $654.32	Professional		$215.04	$280.39	$654.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.79 / $88.84 / $238.31	Professional	26	$66.79	$88.84	$238.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $139.58 / $182.54 / $555.72	Professional	TC	$139.58	$182.54	$555.72