Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $158.49 / $371.54	Facility	26	$57.54	$158.49	$371.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $338.84 / $933.25	Professional		$190.55	$338.84	$933.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $67.61 / $223.87	Professional	26	$52.48	$67.61	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $245.47 / $724.44	Professional	TC	$134.90	$245.47	$724.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	26	$109.65	$109.65	$109.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $524.81 / $912.01	Professional		$316.23	$524.81	$912.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $89.13 / $173.78	Professional	26	$63.10	$89.13	$173.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $436.52 / $741.31	Professional	TC	$234.42	$436.52	$741.31
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $457.09 / $831.76	Professional		$323.59	$457.09	$831.76
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $100.00 / $181.97	Professional	26	$72.44	$100.00	$181.97
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 / $97.72	Facility	26	$14.45	$67.61	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $380.19 / $724.44	Professional		$194.98	$380.19	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $75.86 / $147.91	Professional	26	$42.66	$75.86	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $295.12 / $562.34	Professional	TC	$141.25	$295.12	$562.34
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 $42.66 / $67.61 / $91.20	Professional	26	$42.66	$67.61	$91.20
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $194.98 / $263.03	Professional	TC	$151.36	$194.98	$263.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $251.19 / $467.74	Professional		$190.55	$251.19	$467.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $125.89	Professional	26	$57.54	$77.62	$125.89
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 $549.54 / $549.54 / $549.54	Facility	26	$549.54	$549.54	$549.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,344.23 / $2,344.23 / $2,344.23	Professional		$2,344.23	$2,344.23	$2,344.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $524.81 / $524.81 / $524.81	Professional	26	$524.81	$524.81	$524.81
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Professional	TC	$2,398.83	$2,398.83	$2,398.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $72.44 / $251.19	Professional		$32.36	$72.44	$251.19
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $97.72	Facility	26	$14.45	$67.61	$97.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $398.11 / $630.96	Professional		$194.98	$398.11	$630.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $70.79 / $134.90	Professional	26	$36.31	$70.79	$134.90
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 $758.58 / $758.58 / $758.58	Professional		$758.58	$758.58	$758.58
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	26	$204.17	$204.17	$204.17
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $562.34 / $562.34	Professional	TC	$562.34	$562.34	$562.34
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 $46.77 / $61.66 / $128.82	Professional	26	$46.77	$61.66	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $234.42 / $478.63	Professional	TC	$144.54	$234.42	$478.63