Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.95 / $69.08 / $366.08	Facility	26	$65.95	$69.08	$366.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $215.10 / $368.37 / $1,410.22	Professional		$215.10	$368.37	$1,410.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.25 / $69.08 / $258.95	Professional	26	$59.25	$69.08	$258.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.31 / $306.18 / $1,053.10	Professional	TC	$154.31	$306.18	$1,053.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.70 / $109.22 / $109.22	Professional	26	$47.70	$109.22	$109.22
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $264.95 / $475.12 / $851.98	Professional		$264.95	$475.12	$851.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.27 / $91.87 / $176.12	Professional	26	$64.27	$91.87	$176.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $195.83 / $384.01 / $674.34	Professional	TC	$195.83	$384.01	$674.34
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $249.78 / $380.25 / $901.74	Professional		$249.78	$380.25	$901.74
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.09 / $87.35 / $203.45	Professional	26	$64.09	$87.35	$203.45
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $191.45 / $293.36 / $698.05	Professional	TC	$191.45	$293.36	$698.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.29 / $383.99 / $827.44	Professional		$204.29	$383.99	$827.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.56 / $80.63 / $175.13	Professional	26	$41.56	$80.63	$175.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $156.24 / $297.81 / $627.58	Professional	TC	$156.24	$297.81	$627.58
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $206.28 / $277.18 / $374.19	Professional		$206.28	$277.18	$374.19
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.44 / $66.20 / $89.38	Professional	26	$47.44	$66.20	$89.38
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.84 / $210.97 / $284.81	Professional	TC	$158.84	$210.97	$284.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $203.35 / $277.18 / $502.00	Professional		$203.35	$277.18	$502.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.65 / $79.45 / $129.11	Professional	26	$58.65	$79.45	$129.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $162.63 / $243.96 / $395.58	Professional	TC	$162.63	$243.96	$395.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $546.72 / $546.72 / $561.91	Facility	26	$546.72	$546.72	$561.91
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,999.32 / $2,220.23 / $2,220.23	Professional		$1,999.32	$2,220.23	$2,220.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $479.55 / $590.91 / $590.91	Professional	26	$479.55	$590.91	$590.91
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,624.23 / $1,822.59 / $1,825.48	Professional	TC	$1,624.23	$1,822.59	$1,825.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $198.25	Professional		$32.34	$32.34	$198.25
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $212.50 / $425.17 / $719.93	Professional		$212.50	$425.17	$719.93
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.12 / $79.30 / $167.60	Professional	26	$41.12	$79.30	$167.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $156.24 / $297.81 / $589.01	Professional	TC	$156.24	$297.81	$589.01
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $827.08 / $827.08 / $827.08	Professional		$827.08	$827.08	$827.08
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $205.47 / $205.47 / $205.47	Professional	26	$205.47	$205.47	$205.47
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $621.60 / $621.60 / $621.60	Professional	TC	$621.60	$621.60	$621.60
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $224.18 / $308.24 / $561.23	Professional		$224.18	$308.24	$561.23
United Facility/Professional Professional Modifier Low / Median / High Price $213.81 / $318.02 / $720.97	Professional		$213.81	$318.02	$720.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.01 / $68.14 / $152.03	Professional	26	$53.01	$68.14	$152.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.90 / $248.34 / $594.99	Professional	TC	$158.90	$248.34	$594.99