Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.78 / $69.43 / $371.21	Facility	26	$62.78	$69.43	$371.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $214.77 / $362.37 / $1,113.00	Professional		$214.77	$362.37	$1,113.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.52 / $96.14 / $287.61	Professional	26	$62.52	$96.14	$287.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.71 / $168.03 / $689.99	Professional	TC	$142.71	$168.03	$689.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $159.87 / $241.58 / $478.06	Professional		$159.87	$241.58	$478.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.11 / $122.76 / $317.35	Professional	26	$53.11	$122.76	$317.35
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $264.08 / $364.68 / $693.72	Professional		$264.08	$364.68	$693.72
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $73.73 / $118.81 / $219.71	Professional	26	$73.73	$118.81	$219.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.48 / $253.17 / $509.30	Professional	TC	$181.48	$253.17	$509.30
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $163.96 / $268.97 / $665.99	Professional		$163.96	$268.97	$665.99
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.22 / $81.23 / $190.48	Professional	26	$64.22	$81.23	$190.48
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $114.02 / $192.07 / $475.20	Professional	TC	$114.02	$192.07	$475.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.50 / $69.50 / $69.50	Facility	26	$69.50	$69.50	$69.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.51 / $310.92 / $698.76	Professional		$223.51	$310.92	$698.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.11 / $87.48 / $178.63	Professional	26	$66.11	$87.48	$178.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.07 / $231.98 / $535.73	Professional	TC	$162.07	$231.98	$535.73
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $152.65 / $279.93 / $377.91	Professional		$152.65	$279.93	$377.91
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $67.44 / $91.04	Professional	26	$54.95	$67.44	$91.04
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.70 / $185.87 / $286.86	Professional	TC	$97.70	$185.87	$286.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $216.21 / $280.33 / $539.80	Professional		$216.21	$280.33	$539.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.63 / $84.02 / $141.40	Professional	26	$59.63	$84.02	$141.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $163.88 / $249.28 / $416.81	Professional	TC	$163.88	$249.28	$416.81
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $143.07 / $296.77 / $314.00	Facility	26	$143.07	$296.77	$314.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,442.20 / $1,442.20 / $1,800.98	Professional		$1,442.20	$1,442.20	$1,800.98
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $482.10 / $507.29 / $507.29	Professional	26	$482.10	$507.29	$507.29
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,055.58 / $1,055.58 / $1,318.88	Professional	TC	$1,055.58	$1,055.58	$1,318.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $213.57	Professional		$32.34	$32.34	$213.57
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.50 / $69.50 / $69.50	Facility	26	$69.50	$69.50	$69.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $224.26 / $339.05 / $651.60	Professional		$224.26	$339.05	$651.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.11 / $85.52 / $172.14	Professional	26	$66.11	$85.52	$172.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $161.40 / $228.57 / $525.60	Professional	TC	$161.40	$228.57	$525.60
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $780.60 / $780.60 / $780.60	Professional		$780.60	$780.60	$780.60
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $208.28 / $208.28 / $208.28	Professional	26	$208.28	$208.28	$208.28
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $572.30 / $572.30 / $572.30	Professional	TC	$572.30	$572.30	$572.30
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $226.41 / $311.31 / $416.56	Professional		$226.41	$311.31	$416.56
United Facility/Professional Professional Modifier Low / Median / High Price $182.98 / $253.64 / $625.53	Professional		$182.98	$253.64	$625.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.68 / $72.39 / $175.66	Professional	26	$50.68	$72.39	$175.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.06 / $186.03 / $532.07	Professional	TC	$132.06	$186.03	$532.07