Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $91.20 / $158.49	Facility	26	$61.66	$91.20	$158.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $389.05 / $1,348.96	Professional		$199.53	$389.05	$1,348.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $87.10 / $281.84	Professional	26	$56.23	$87.10	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $288.40 / $741.31	Professional	TC	$141.25	$288.40	$741.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $177.83 / $269.15	Professional		$141.25	$177.83	$269.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $85.11 / $134.90	Professional	26	$35.48	$85.11	$134.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $302.00 / $302.00	Professional	TC	$302.00	$302.00	$302.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $524.81 / $891.25	Professional		$309.03	$524.81	$891.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $95.50 / $186.21	Professional	26	$67.61	$95.50	$186.21
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $436.52 / $691.83	Professional	TC	$234.42	$436.52	$691.83
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $467.74 / $831.76	Professional		$323.59	$467.74	$831.76
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $109.65 / $199.53	Professional	26	$79.43	$109.65	$199.53
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $354.81 / $630.96	Professional	TC	$245.47	$354.81	$630.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $380.19 / $707.95	Professional		$194.98	$380.19	$707.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $79.43 / $158.49	Professional	26	$42.66	$79.43	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $288.40 / $549.54	Professional	TC	$141.25	$288.40	$549.54
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $263.03 / $354.81	Professional		$190.55	$263.03	$354.81
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $66.07 / $89.13	Professional	26	$45.71	$66.07	$89.13
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $194.98 / $263.03	Professional	TC	$144.54	$194.98	$263.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $251.19 / $416.87	Professional		$190.55	$251.19	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $75.86 / $123.03	Professional	26	$57.54	$75.86	$123.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $208.93 / $363.08	Professional	TC	$162.18	$208.93	$363.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $537.03 / $537.03 / $537.03	Facility	26	$537.03	$537.03	$537.03
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Professional		$2,398.83	$2,398.83	$2,398.83
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $537.03 / $537.03 / $537.03	Professional	26	$537.03	$537.03	$537.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,041.74 / $2,041.74 / $2,041.74	Professional	TC	$2,041.74	$2,041.74	$2,041.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $70.79 / $257.04	Professional		$32.36	$70.79	$257.04
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $398.11 / $645.65	Professional		$199.53	$398.11	$645.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $75.86 / $138.04	Professional	26	$39.81	$75.86	$138.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $288.40 / $549.54	Professional	TC	$141.25	$288.40	$549.54
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $776.25 / $776.25	Professional		$776.25	$776.25	$776.25
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 $549.54 / $549.54 / $549.54	Professional	TC	$549.54	$549.54	$549.54
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $295.12 / $616.60	Professional		$213.80	$295.12	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $295.12 / $602.56	Professional		$199.53	$295.12	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $66.07 / $141.25	Professional	26	$50.12	$66.07	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $234.42 / $478.63	Professional	TC	$141.25	$234.42	$478.63