Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.24 / $61.04 / $368.52	Facility	26	$58.24	$61.04	$368.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.83 / $314.94 / $1,077.33	Professional		$183.83	$314.94	$1,077.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.86 / $76.91 / $291.45	Professional	26	$54.86	$76.91	$291.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.04 / $256.70 / $518.85	Professional	TC	$123.04	$256.70	$518.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $98.19 / $131.50 / $176.73	Professional		$98.19	$131.50	$176.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.79 / $50.14 / $98.92	Professional	26	$35.79	$50.14	$98.92
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $209.86 / $384.25 / $702.79	Professional		$209.86	$384.25	$702.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.96 / $81.72 / $158.84	Professional	26	$56.96	$81.72	$158.84
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $140.19 / $304.80 / $551.47	Professional	TC	$140.19	$304.80	$551.47
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $158.33 / $242.36 / $590.72	Professional		$158.33	$242.36	$590.72
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.73 / $77.26 / $186.25	Professional	26	$56.73	$77.26	$186.25
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $106.78 / $166.20 / $398.10	Professional	TC	$106.78	$166.20	$398.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $163.44 / $315.00 / $582.39	Professional		$163.44	$315.00	$582.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.65 / $73.83 / $168.73	Professional	26	$36.65	$73.83	$168.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.16 / $224.54 / $434.90	Professional	TC	$110.16	$224.54	$434.90
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $168.04 / $226.23 / $305.41	Professional		$168.04	$226.23	$305.41
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.77 / $66.67 / $90.00	Professional	26	$53.77	$66.67	$90.00
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.27 / $159.56 / $215.41	Professional	TC	$114.27	$159.56	$215.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $175.60 / $228.69 / $383.00	Professional		$175.60	$228.69	$383.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.01 / $80.00 / $130.01	Professional	26	$59.01	$80.00	$130.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.04 / $184.56 / $299.25	Professional	TC	$123.04	$184.56	$299.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $549.76 / $549.76 / $565.04	Facility	26	$549.76	$549.76	$565.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,897.57 / $1,954.49 / $1,954.49	Professional		$1,897.57	$1,954.49	$1,954.49
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $435.88 / $435.88 / $482.33	Professional	26	$435.88	$435.88	$482.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,600.00 / $1,624.23 / $1,624.23	Professional	TC	$1,600.00	$1,624.23	$1,624.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $132.27	Professional		$32.34	$32.34	$132.27
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $163.53 / $342.27 / $543.00	Professional		$163.53	$342.27	$543.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.33 / $72.89 / $163.77	Professional	26	$36.33	$72.89	$163.77
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $107.36 / $225.15 / $422.43	Professional	TC	$107.36	$225.15	$422.43
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $636.49 / $636.49 / $636.49	Professional		$636.49	$636.49	$636.49
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $206.68 / $206.68 / $206.68	Professional	26	$206.68	$206.68	$206.68
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $429.81 / $429.81 / $429.81	Professional	TC	$429.81	$429.81	$429.81
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $182.95 / $251.56 / $561.23	Professional		$182.95	$251.56	$561.23
United Facility/Professional Professional Modifier Low / Median / High Price $165.04 / $245.08 / $549.57	Professional		$165.04	$245.08	$549.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.23 / $64.95 / $154.47	Professional	26	$49.23	$64.95	$154.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.82 / $171.84 / $398.20	Professional	TC	$109.82	$171.84	$398.20