Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.68 / $58.30 / $353.83	Facility	26	$55.68	$58.30	$353.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $172.48 / $315.56 / $1,031.96	Professional		$172.48	$315.56	$1,031.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $62.84 / $251.05	Professional	26	$52.46	$62.84	$251.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $259.87 / $601.24	Professional	TC	$119.70	$259.87	$601.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.77 / $74.80 / $92.92	Professional	26	$45.77	$74.80	$92.92
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $237.79 / $383.35 / $711.35	Professional		$237.79	$383.35	$711.35
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.69 / $78.47 / $152.52	Professional	26	$54.69	$78.47	$152.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $172.11 / $310.37 / $571.65	Professional	TC	$172.11	$310.37	$571.65
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $189.46 / $289.80 / $685.91	Professional		$189.46	$289.80	$685.91
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.11 / $73.79 / $178.04	Professional	26	$54.11	$73.79	$178.04
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $140.22 / $214.81 / $508.32	Professional	TC	$140.22	$214.81	$508.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $65.98	Facility	26	$65.98	$65.98	$65.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $159.01 / $326.01 / $649.41	Professional		$159.01	$326.01	$649.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.70 / $68.52 / $162.26	Professional	26	$34.70	$68.52	$162.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.63 / $246.36 / $504.93	Professional	TC	$113.63	$246.36	$504.93
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $163.08 / $220.20 / $297.27	Professional		$163.08	$220.20	$297.27
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.77 / $63.85 / $86.20	Professional	26	$40.77	$63.85	$86.20
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $122.31 / $156.35 / $211.07	Professional	TC	$122.31	$156.35	$211.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $171.89 / $222.60 / $413.97	Professional		$171.89	$222.60	$413.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.48 / $76.62 / $133.77	Professional	26	$56.48	$76.62	$133.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $120.57 / $180.86 / $293.25	Professional	TC	$120.57	$180.86	$293.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $525.76 / $525.76 / $540.32	Facility	26	$525.76	$525.76	$540.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,882.38 / $1,938.85 / $1,938.85	Professional		$1,882.38	$1,938.85	$1,938.85
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $434.24 / $434.24 / $459.75	Professional	26	$434.24	$434.24	$459.75
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,576.92 / $1,624.23 / $1,624.23	Professional	TC	$1,576.92	$1,624.23	$1,624.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $145.24	Professional		$32.34	$32.34	$145.24
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $65.98	Facility	26	$65.98	$65.98	$65.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $165.92 / $352.64 / $571.21	Professional		$165.92	$352.64	$571.21
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.53 / $66.45 / $159.80	Professional	26	$33.53	$66.45	$159.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $112.80 / $256.51 / $483.51	Professional	TC	$112.80	$256.51	$483.51
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $651.16 / $651.16 / $651.16	Professional		$651.16	$651.16	$651.16
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $198.51 / $198.51 / $198.51	Professional	26	$198.51	$198.51	$198.51
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $452.65 / $452.65 / $452.65	Professional	TC	$452.65	$452.65	$452.65
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $178.08 / $244.86 / $618.24	Professional		$178.08	$244.86	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $168.72 / $258.04 / $586.58	Professional		$168.72	$258.04	$586.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.30 / $63.06 / $152.63	Professional	26	$47.30	$63.06	$152.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.64 / $188.00 / $420.83	Professional	TC	$115.64	$188.00	$420.83