Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.95 / $73.87 / $402.38	Facility	26	$62.95	$73.87	$402.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $202.59 / $329.33 / $1,172.06	Professional		$202.59	$329.33	$1,172.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.95 / $100.73 / $325.00	Professional	26	$62.95	$100.73	$325.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.05 / $251.06 / $756.49	Professional	TC	$129.05	$251.06	$756.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.35 / $187.37 / $409.88	Professional		$154.35	$187.37	$409.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.32 / $84.81 / $156.04	Professional	26	$49.32	$84.81	$156.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $159.12 / $159.12 / $159.12	Professional	TC	$159.12	$159.12	$159.12
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $244.43 / $369.72 / $671.62	Professional		$244.43	$369.72	$671.62
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.84 / $88.72 / $172.43	Professional	26	$61.84	$88.72	$172.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $163.95 / $284.25 / $495.07	Professional	TC	$163.95	$284.25	$495.07
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $194.78 / $298.74 / $715.22	Professional		$194.78	$298.74	$715.22
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $61.62 / $84.07 / $203.46	Professional	26	$61.62	$84.07	$203.46
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $138.72 / $213.56 / $504.27	Professional	TC	$138.72	$213.56	$504.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.84 / $74.84 / $74.84	Facility	26	$74.84	$74.84	$74.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.39 / $315.24 / $616.90	Professional		$165.39	$315.24	$616.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.76 / $78.00 / $183.83	Professional	26	$39.76	$78.00	$183.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $115.40 / $227.22 / $454.29	Professional	TC	$115.40	$227.22	$454.29
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $178.55 / $239.74 / $323.64	Professional		$178.55	$239.74	$323.64
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.99 / $72.38 / $97.71	Professional	26	$49.99	$72.38	$97.71
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.56 / $167.36 / $225.94	Professional	TC	$128.56	$167.36	$225.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $182.17 / $242.43 / $397.64	Professional		$182.17	$242.43	$397.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.03 / $86.86 / $151.66	Professional	26	$64.03	$86.86	$151.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $129.05 / $193.58 / $313.88	Professional	TC	$129.05	$193.58	$313.88
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $596.24 / $596.24 / $612.88	Facility	26	$596.24	$596.24	$612.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,657.47 / $1,680.90 / $1,680.90	Professional		$1,657.47	$1,680.90	$1,680.90
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $414.94 / $414.94 / $522.08	Professional	26	$414.94	$414.94	$522.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,425.00 / $1,425.00 / $1,425.00	Professional	TC	$1,425.00	$1,425.00	$1,425.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $150.41	Professional		$32.34	$32.34	$150.41
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $74.84 / $74.84 / $74.84	Facility	26	$74.84	$74.84	$74.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $171.91 / $347.70 / $581.84	Professional		$171.91	$347.70	$581.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.29 / $76.48 / $177.74	Professional	26	$39.29	$76.48	$177.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $115.40 / $226.26 / $426.90	Professional	TC	$115.40	$226.26	$426.90
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $674.41 / $674.41 / $674.41	Professional		$674.41	$674.41	$674.41
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $225.36 / $225.36 / $225.36	Professional	26	$225.36	$225.36	$225.36
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $449.04 / $449.04 / $449.04	Professional	TC	$449.04	$449.04	$449.04
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $193.89 / $266.60 / $561.23	Professional		$193.89	$266.60	$561.23
United Facility/Professional Professional Modifier Low / Median / High Price $174.85 / $246.11 / $557.96	Professional		$174.85	$246.11	$557.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.38 / $70.73 / $166.78	Professional	26	$53.38	$70.73	$166.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.72 / $175.88 / $407.90	Professional	TC	$114.72	$175.88	$407.90