Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $140.00 / $140.00 / $464.09	Facility	26	$140.00	$140.00	$464.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $209.84 / $475.00 / $1,456.51	Professional		$209.84	$475.00	$1,456.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.48 / $140.00 / $351.27	Professional	26	$70.48	$140.00	$351.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.34 / $335.00 / $485.75	Professional	TC	$136.34	$335.00	$485.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $198.00 / $210.38 / $1,166.45	Professional		$198.00	$210.38	$1,166.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.06 / $152.91 / $170.50	Professional	26	$62.06	$152.91	$170.50
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.88 / $415.19 / $743.45	Professional		$251.88	$415.19	$743.45
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.42 / $122.09 / $223.32	Professional	26	$80.42	$122.09	$223.32
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $167.94 / $287.14 / $520.12	Professional	TC	$167.94	$287.14	$520.12
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $191.88 / $296.54 / $716.39	Professional		$191.88	$296.54	$716.39
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.06 / $89.03 / $206.36	Professional	26	$64.06	$89.03	$206.36
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $133.44 / $208.95 / $502.23	Professional	TC	$133.44	$208.95	$502.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.45 / $86.45 / $86.45	Facility	26	$86.45	$86.45	$86.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $157.76 / $306.41 / $726.76	Professional		$157.76	$306.41	$726.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.99 / $92.61 / $213.40	Professional	26	$43.99	$92.61	$213.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.77 / $210.04 / $500.71	Professional	TC	$113.77	$210.04	$500.71
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $214.07 / $285.27 / $385.11	Professional		$214.07	$285.27	$385.11
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.22 / $83.94 / $113.32	Professional	26	$64.22	$83.94	$113.32
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $149.85 / $201.33 / $271.80	Professional	TC	$149.85	$201.33	$271.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $222.75 / $298.31 / $553.70	Professional		$222.75	$298.31	$553.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.55 / $104.93 / $400.00	Professional	26	$75.55	$104.93	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $171.65 / $241.60 / $500.00	Professional	TC	$171.65	$241.60	$500.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $691.52 / $691.52 / $707.68	Facility	26	$691.52	$691.52	$707.68
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,484.56 / $1,484.56 / $1,852.58	Professional		$1,484.56	$1,484.56	$1,852.58
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $478.82 / $478.82 / $605.54	Professional	26	$478.82	$478.82	$605.54
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,005.68 / $1,005.68 / $1,247.03	Professional	TC	$1,005.68	$1,005.68	$1,247.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $163.75	Professional		$32.34	$32.34	$163.75
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $86.45 / $86.45 / $86.45	Facility	26	$86.45	$86.45	$86.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $167.31 / $358.21 / $687.28	Professional		$167.31	$358.21	$687.28
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.83 / $90.35 / $212.01	Professional	26	$41.83	$90.35	$212.01
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.37 / $205.99 / $500.71	Professional	TC	$95.37	$205.99	$500.71
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $838.09 / $838.09 / $838.09	Professional		$838.09	$838.09	$838.09
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $260.41 / $260.41 / $260.41	Professional	26	$260.41	$260.41	$260.41
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $577.66 / $577.66 / $577.66	Professional	TC	$577.66	$577.66	$577.66
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $230.70 / $299.70 / $363.92	Professional		$230.70	$299.70	$363.92
United Facility/Professional Professional Modifier Low / Median / High Price $217.18 / $458.33 / $1,115.32	Professional		$217.18	$458.33	$1,115.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.73 / $81.92 / $186.41	Professional	26	$59.73	$81.92	$186.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.55 / $341.51 / $909.94	Professional	TC	$147.55	$341.51	$909.94