Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.70 / $67.76 / $368.52	Facility	26	$64.70	$67.76	$368.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $189.01 / $349.43 / $1,179.25	Professional		$189.01	$349.43	$1,179.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.11 / $67.76 / $199.57	Professional	26	$58.11	$67.76	$199.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $127.78 / $288.45 / $820.11	Professional	TC	$127.78	$288.45	$820.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $139.28 / $194.22 / $329.83	Professional		$139.28	$194.22	$329.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.58 / $52.30 / $134.06	Professional	26	$35.58	$52.30	$134.06
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $249.31 / $449.96 / $740.54	Professional		$249.31	$449.96	$740.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.00 / $91.28 / $177.19	Professional	26	$63.00	$91.28	$177.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $160.78 / $355.79 / $570.66	Professional	TC	$160.78	$355.79	$570.66
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $169.38 / $259.57 / $632.15	Professional		$169.38	$259.57	$632.15
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.35 / $76.78 / $185.03	Professional	26	$56.35	$76.78	$185.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $118.12 / $183.84 / $440.61	Professional	TC	$118.12	$183.84	$440.61
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 $173.94 / $346.09 / $636.42	Professional		$173.94	$346.09	$636.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.33 / $78.53 / $169.47	Professional	26	$40.33	$78.53	$169.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $121.27 / $260.97 / $503.17	Professional	TC	$121.27	$260.97	$503.17
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $179.54 / $240.92 / $325.24	Professional		$179.54	$240.92	$325.24
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.86 / $66.20 / $89.38	Professional	26	$53.86	$66.20	$89.38
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.68 / $174.71 / $235.86	Professional	TC	$125.68	$174.71	$235.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $182.56 / $243.41 / $417.46	Professional		$182.56	$243.41	$417.46
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 $134.71 / $202.07 / $327.64	Professional	TC	$134.71	$202.07	$327.64
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 $1,989.67 / $2,075.08 / $2,075.08	Professional		$1,989.67	$2,075.08	$2,075.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $460.66 / $460.66 / $479.55	Professional	26	$460.66	$460.66	$479.55
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,624.23 / $1,685.33 / $1,726.78	Professional	TC	$1,624.23	$1,685.33	$1,726.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $122.33	Professional		$32.34	$32.34	$122.33
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 $174.93 / $375.00 / $592.87	Professional		$174.93	$375.00	$592.87
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $77.38 / $162.69	Professional	26	$36.54	$77.38	$162.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $121.27 / $273.25 / $479.53	Professional	TC	$121.27	$273.25	$479.53
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $678.57 / $678.57 / $678.57	Professional		$678.57	$678.57	$678.57
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 $471.89 / $471.89 / $471.89	Professional	TC	$471.89	$471.89	$471.89
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $194.84 / $267.91 / $561.23	Professional		$194.84	$267.91	$561.23
United Facility/Professional Professional Modifier Low / Median / High Price $175.77 / $283.45 / $611.25	Professional		$175.77	$283.45	$611.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.04 / $68.14 / $152.97	Professional	26	$55.04	$68.14	$152.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.55 / $225.87 / $484.36	Professional	TC	$120.55	$225.87	$484.36