Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $120.23 / $457.09	Facility	26	$87.10	$120.23	$457.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $380.19 / $1,122.02	Professional		$234.42	$380.19	$1,122.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $131.83 / $389.05	Professional	26	$81.28	$131.83	$389.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $181.97 / $457.09	Professional	TC	$144.54	$181.97	$457.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $257.04 / $549.54	Professional		$204.17	$257.04	$549.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $169.82 / $199.53	Professional	26	$67.61	$169.82	$199.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $407.38 / $724.44	Professional		$302.00	$407.38	$724.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $181.97 / $275.42	Professional	26	$123.03	$181.97	$275.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $245.47 / $457.09	Professional	TC	$138.04	$245.47	$457.09
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $398.11 / $758.58	Professional		$275.42	$398.11	$758.58
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $141.25 / $263.03	Professional	26	$100.00	$141.25	$263.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $263.03 / $501.19	Professional	TC	$177.83	$263.03	$501.19
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 $245.47 / $354.81 / $616.60	Professional		$245.47	$354.81	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $120.23 / $218.78	Professional	26	$89.13	$120.23	$218.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $223.87 / $426.58	Professional	TC	$154.88	$223.87	$426.58
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $309.03 / $416.87	Professional		$245.47	$309.03	$416.87
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $123.03 / $147.91	Professional	26	$95.50	$123.03	$147.91
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $213.80 / $288.40	Professional	TC	$123.03	$213.80	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $288.40 / $512.86	Professional		$223.87	$288.40	$512.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $112.20 / $199.53	Professional	26	$83.18	$112.20	$199.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $239.88 / $407.38	Professional	TC	$165.96	$239.88	$407.38
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $524.81 / $524.81 / $524.81	Facility	26	$524.81	$524.81	$524.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Professional		$2,398.83	$2,398.83	$2,398.83
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $524.81 / $645.65 / $645.65	Professional	26	$524.81	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $977.24 / $1,258.93 / $1,258.93	Professional	TC	$977.24	$1,258.93	$1,258.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $204.17 / $316.23	Professional		$117.49	$204.17	$316.23
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 $245.47 / $363.08 / $616.60	Professional		$245.47	$363.08	$616.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $120.23 / $208.93	Professional	26	$89.13	$120.23	$208.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $213.80 / $416.87	Professional	TC	$154.88	$213.80	$416.87
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $776.25 / $776.25	Professional		$776.25	$776.25	$776.25
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 $501.19 / $501.19 / $501.19	Professional	TC	$501.19	$501.19	$501.19
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $323.59 / $416.87	Professional		$245.47	$323.59	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $275.42 / $537.03	Professional		$194.98	$275.42	$537.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $102.33 / $186.21	Professional	26	$69.18	$102.33	$186.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $173.78 / $346.74	Professional	TC	$123.03	$173.78	$346.74