Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.04 / $58.71 / $353.83	Facility	26	$56.04	$58.71	$353.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.63 / $316.26 / $1,110.28	Professional		$178.63	$316.26	$1,110.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $63.13 / $290.00	Professional	26	$52.78	$63.13	$290.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $260.23 / $601.24	Professional	TC	$119.70	$260.23	$601.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.08 / $90.22 / $137.94	Professional	26	$46.08	$90.22	$137.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $230.22 / $383.35 / $715.94	Professional		$230.22	$383.35	$715.94
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 $162.47 / $310.37 / $571.65	Professional	TC	$162.47	$310.37	$571.65
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $189.76 / $290.25 / $686.19	Professional		$189.76	$290.25	$686.19
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.11 / $73.79 / $177.64	Professional	26	$54.11	$73.79	$177.64
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $140.51 / $215.27 / $513.52	Professional	TC	$140.51	$215.27	$513.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.34 / $66.34 / $66.34	Facility	26	$66.34	$66.34	$66.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $160.15 / $326.12 / $649.63	Professional		$160.15	$326.12	$649.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.94 / $68.52 / $162.26	Professional	26	$34.94	$68.52	$162.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.62 / $249.17 / $505.62	Professional	TC	$114.62	$249.17	$505.62
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $164.34 / $222.18 / $299.94	Professional		$164.34	$222.18	$299.94
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.09 / $63.99 / $86.39	Professional	26	$41.09	$63.99	$86.39
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.26 / $158.18 / $213.54	Professional	TC	$123.26	$158.18	$213.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.48 / $224.59 / $417.70	Professional		$173.48	$224.59	$417.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.66 / $76.79 / $134.18	Professional	26	$56.66	$76.79	$134.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $121.98 / $182.97 / $296.68	Professional	TC	$121.98	$182.97	$296.68
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $528.08 / $528.08 / $542.79	Facility	26	$528.08	$528.08	$542.79
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,884.77 / $1,941.31 / $1,941.31	Professional		$1,884.77	$1,941.31	$1,941.31
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $434.24 / $434.24 / $463.80	Professional	26	$434.24	$434.24	$463.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,950.00 / $1,950.00 / $1,950.00	Professional	TC	$1,950.00	$1,950.00	$1,950.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $152.36	Professional		$32.34	$32.34	$152.36
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $66.34 / $66.34 / $66.34	Facility	26	$66.34	$66.34	$66.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $166.87 / $352.64 / $574.69	Professional		$166.87	$352.64	$574.69
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.53 / $66.30 / $160.90	Professional	26	$33.53	$66.30	$160.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.12 / $256.51 / $484.55	Professional	TC	$114.12	$256.51	$484.55
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $655.98 / $655.98 / $655.98	Professional		$655.98	$655.98	$655.98
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 $457.46 / $457.46 / $457.46	Professional	TC	$457.46	$457.46	$457.46
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $179.67 / $247.05 / $618.24	Professional		$179.67	$247.05	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $169.95 / $252.37 / $549.38	Professional		$169.95	$252.37	$549.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.30 / $67.11 / $149.72	Professional	26	$47.30	$67.11	$149.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.88 / $187.23 / $413.16	Professional	TC	$116.88	$187.23	$413.16