Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $229.28 / $717.00 / $1,597.88	Facility		$229.28	$717.00	$1,597.88
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.83 / $33.47 / $219.67	Facility	26	$30.83	$33.47	$219.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.40 / $230.23 / $859.00	Professional		$182.40	$230.23	$859.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.82 / $38.79 / $134.00	Professional	26	$30.82	$38.79	$134.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $145.19 / $169.96 / $415.18	Professional	TC	$145.19	$169.96	$415.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.15 / $181.27 / $181.27	Professional		$134.15	$181.27	$181.27
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $27.29 / $293.00 / $876.00	Facility		$27.29	$293.00	$876.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $164.49 / $247.99 / $510.27	Professional		$164.49	$247.99	$510.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.64 / $43.00 / $89.19	Professional	26	$28.64	$43.00	$89.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $135.59 / $206.29 / $414.84	Professional	TC	$135.59	$206.29	$414.84
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $59.90 / $232.80 / $1,366.17	Facility		$59.90	$232.80	$1,366.17
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $159.54 / $264.23 / $632.70	Professional		$159.54	$264.23	$632.70
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $42.50 / $100.12	Professional	26	$33.54	$42.50	$100.12
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $133.44 / $222.71 / $532.57	Professional	TC	$133.44	$222.71	$532.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $302.89 / $789.89 / $3,999.20	Facility		$302.89	$789.89	$3,999.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.31 / $43.31 / $43.31	Facility	26	$43.31	$43.31	$43.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $197.54 / $294.50 / $587.23	Professional		$197.54	$294.50	$587.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.47 / $47.07 / $105.37	Professional	26	$33.47	$47.07	$105.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $157.52 / $244.14 / $483.36	Professional	TC	$157.52	$244.14	$483.36
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $164.15 / $233.65 / $315.43	Professional		$164.15	$233.65	$315.43
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.97 / $44.32 / $66.48	Professional	26	$39.97	$44.32	$66.48
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $119.83 / $182.38 / $261.45	Professional	TC	$119.83	$182.38	$261.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $180.04 / $234.14 / $411.82	Professional		$180.04	$234.14	$411.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.97 / $49.98 / $85.47	Professional	26	$35.97	$49.98	$85.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $154.94 / $227.23 / $379.91	Professional	TC	$154.94	$227.23	$379.91
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $357.23 / $814.41 / $956.70	Facility		$357.23	$814.41	$956.70
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $87.37 / $172.60 / $181.17	Facility	26	$87.37	$172.60	$181.17
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,459.71 / $1,499.71 / $1,520.10	Professional		$1,459.71	$1,499.71	$1,520.10
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $361.59 / $361.59 / $361.59	Professional	26	$361.59	$361.59	$361.59
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,202.93 / $1,274.61 / $1,309.54	Professional	TC	$1,202.93	$1,274.61	$1,309.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $191.71	Professional		$32.34	$32.34	$191.71
Providence Facility/Professional Facility Modifier Low / Median / High Price $191.20 / $256.64 / $508.10	Facility		$191.20	$256.64	$508.10
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.31 / $43.31 / $43.31	Facility	26	$43.31	$43.31	$43.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $205.68 / $318.64 / $559.48	Professional		$205.68	$318.64	$559.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.47 / $46.36 / $98.78	Professional	26	$33.47	$46.36	$98.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $157.52 / $244.14 / $471.53	Professional	TC	$157.52	$244.14	$471.53
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $629.41 / $629.41 / $629.41	Professional		$629.41	$629.41	$629.41
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $125.62 / $125.62 / $125.62	Professional	26	$125.62	$125.62	$125.62
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $503.79 / $503.79 / $503.79	Professional	TC	$503.79	$503.79	$503.79
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $188.90 / $259.74 / $423.82	Professional		$188.90	$259.74	$423.82
United Facility/Professional Professional Modifier Low / Median / High Price $149.35 / $228.76 / $540.72	Professional		$149.35	$228.76	$540.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $40.42 / $102.26	Professional	26	$28.84	$40.42	$102.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.60 / $190.63 / $458.98	Professional	TC	$117.60	$190.63	$458.98