Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $61.66 / $128.82	Facility	26	$45.71	$61.66	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $269.15 / $954.99	Professional		$138.04	$269.15	$954.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $70.79 / $208.93	Professional	26	$43.65	$70.79	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $199.53 / $436.52	Professional	TC	$91.20	$199.53	$436.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $162.18 / $288.40	Professional		$114.82	$162.18	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $83.18 / $109.65	Professional	26	$22.39	$83.18	$109.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $363.08 / $602.56	Professional		$229.09	$363.08	$602.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $81.28 / $144.54	Professional	26	$53.70	$81.28	$144.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $281.84 / $467.74	Professional	TC	$158.49	$281.84	$467.74
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $275.42 / $524.81	Professional		$190.55	$275.42	$524.81
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $79.43 / $144.54	Professional	26	$57.54	$79.43	$144.54
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $199.53 / $371.54	Professional	TC	$134.90	$199.53	$371.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $263.03 / $489.78	Professional		$125.89	$263.03	$489.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $63.10 / $117.49	Professional	26	$33.88	$63.10	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $186.21 / $363.08	Professional	TC	$89.13	$186.21	$363.08
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $169.82 / $229.09	Professional		$125.89	$169.82	$229.09
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $53.70 / $72.44	Professional	26	$32.36	$53.70	$72.44
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $117.49 / $158.49	Professional	TC	$93.33	$117.49	$158.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $169.82 / $323.59	Professional		$125.89	$169.82	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $100.00	Professional	26	$46.77	$61.66	$100.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $128.82 / $223.87	Professional	TC	$100.00	$128.82	$223.87
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $426.58 / $426.58	Facility	26	$426.58	$426.58	$426.58
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $1,659.59 / $1,659.59	Professional		$295.12	$1,659.59	$1,659.59
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $380.19 / $380.19 / $380.19	Professional	26	$380.19	$380.19	$380.19
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,348.96 / $1,348.96 / $1,348.96	Professional	TC	$1,348.96	$1,348.96	$1,348.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $56.23 / $151.36	Professional		$32.36	$56.23	$151.36
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $269.15 / $436.52	Professional		$128.82	$269.15	$436.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $60.26 / $102.33	Professional	26	$29.51	$60.26	$102.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $186.21 / $363.08	Professional	TC	$85.11	$186.21	$363.08
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $512.86 / $512.86	Professional		$512.86	$512.86	$512.86
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	26	$162.18	$162.18	$162.18
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $354.81 / $354.81	Professional	TC	$354.81	$354.81	$354.81
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $190.55 / $562.34	Professional		$138.04	$190.55	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $199.53 / $407.38	Professional		$134.90	$199.53	$407.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $50.12 / $104.71	Professional	26	$41.69	$50.12	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $147.91 / $309.03	Professional	TC	$91.20	$147.91	$309.03