Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $79.43 / $177.83	Facility	26	$61.66	$79.43	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $371.54 / $1,318.26	Professional		$199.53	$371.54	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $112.20 / $316.23	Professional	26	$61.66	$112.20	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $251.19 / $758.58	Professional	TC	$120.23	$251.19	$758.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $229.09 / $331.13	Professional		$117.49	$229.09	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $120.23 / $151.36	Professional	26	$56.23	$120.23	$151.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $131.83 / $251.19	Professional	TC	$83.18	$131.83	$251.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $407.38 / $707.95	Professional		$269.15	$407.38	$707.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $95.50 / $177.83	Professional	26	$69.18	$95.50	$177.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $309.03 / $524.81	Professional	TC	$199.53	$309.03	$524.81
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $398.11 / $741.31	Professional		$275.42	$398.11	$741.31
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $109.65 / $204.17	Professional	26	$79.43	$109.65	$204.17
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $288.40 / $524.81	Professional	TC	$199.53	$288.40	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $74.13 / $107.15	Facility	26	$15.85	$74.13	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $309.03 / $575.44	Professional		$173.78	$309.03	$575.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $79.43 / $158.49	Professional	26	$46.77	$79.43	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $223.87 / $416.87	Professional	TC	$117.49	$223.87	$416.87
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $239.88 / $323.59	Professional		$177.83	$239.88	$323.59
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $72.44 / $97.72	Professional	26	$50.12	$72.44	$97.72
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $169.82 / $229.09	Professional	TC	$128.82	$169.82	$229.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $234.42 / $416.87	Professional		$177.83	$234.42	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $83.18 / $138.04	Professional	26	$64.57	$83.18	$138.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $181.97 / $316.23	Professional	TC	$141.25	$181.97	$316.23
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $602.56 / $602.56 / $602.56	Facility	26	$602.56	$602.56	$602.56
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $1,659.59 / $1,698.24	Professional		$575.44	$1,659.59	$1,698.24
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $416.87 / $524.81 / $524.81	Professional	26	$416.87	$524.81	$524.81
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,412.54 / $1,412.54 / $1,412.54	Professional	TC	$1,412.54	$1,412.54	$1,412.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $77.62 / $218.78	Professional		$32.36	$77.62	$218.78
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $74.13 / $107.15	Facility	26	$15.85	$74.13	$107.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $323.59 / $524.81	Professional		$173.78	$323.59	$524.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $72.44 / $141.25	Professional	26	$39.81	$72.44	$141.25
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $218.78 / $398.11	Professional	TC	$114.82	$218.78	$398.11
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $676.08 / $676.08	Professional		$676.08	$676.08	$676.08
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $223.87 / $223.87 / $223.87	Professional	26	$223.87	$223.87	$223.87
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $446.68 / $446.68	Professional	TC	$446.68	$446.68	$446.68
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $269.15 / $562.34	Professional		$194.98	$269.15	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $245.47 / $489.78	Professional		$173.78	$245.47	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $67.61 / $141.25	Professional	26	$51.29	$67.61	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $177.83 / $354.81	Professional	TC	$114.82	$177.83	$354.81