Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $186.21 / $281.84	Facility	26	$141.25	$186.21	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $524.81 / $1,412.54	Professional		$213.80	$524.81	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $141.25 / $389.05	Professional	26	$70.79	$141.25	$389.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $158.49 / $316.23 / $562.34	Professional	52	$158.49	$316.23	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $338.84 / $812.83	Professional	TC	$112.20	$338.84	$812.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $194.98 / $446.68	Professional		$125.89	$194.98	$446.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $117.49 / $162.18	Professional	26	$66.07	$117.49	$162.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $112.20 / $257.04	Professional	TC	$93.33	$112.20	$257.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $616.60 / $977.24	Professional		$331.13	$616.60	$977.24
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $112.20 / $208.93	Professional	26	$77.62	$112.20	$208.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $512.86 / $794.33	Professional	TC	$218.78	$512.86	$794.33
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $380.19 / $707.95	Professional		$263.03	$380.19	$707.95
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $117.49 / $213.80	Professional	26	$85.11	$117.49	$213.80
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $263.03 / $478.63	Professional	TC	$177.83	$263.03	$478.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $398.11 / $812.83	Professional		$186.21	$398.11	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $93.33 / $181.97	Professional	26	$50.12	$93.33	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $288.40 / $645.65	Professional	TC	$123.03	$288.40	$645.65
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $251.19 / $338.84	Professional		$186.21	$251.19	$338.84
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $77.62 / $104.71	Professional	26	$58.88	$77.62	$104.71
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $173.78 / $234.42	Professional	TC	$125.89	$173.78	$234.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $251.19 / $489.78	Professional		$186.21	$251.19	$489.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $93.33 / $173.78	Professional	26	$70.79	$93.33	$173.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $199.53 / $338.84	Professional	TC	$144.54	$199.53	$338.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	26	$645.65	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $3,019.95 / $3,019.95	Professional		$389.05	$3,019.95	$3,019.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $562.34 / $562.34 / $562.34	Professional	26	$562.34	$562.34	$562.34
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,570.40 / $2,570.40 / $2,570.40	Professional	TC	$2,570.40	$2,570.40	$2,570.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $83.18 / $223.87	Professional		$32.36	$83.18	$223.87
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $398.11 / $758.58	Professional		$186.21	$398.11	$758.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $89.13 / $158.49	Professional	26	$45.71	$89.13	$158.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $302.00 / $645.65	Professional	TC	$120.23	$302.00	$645.65
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $724.44 / $724.44	Professional		$724.44	$724.44	$724.44
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $239.88 / $239.88	Professional	26	$239.88	$239.88	$239.88
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $478.63 / $478.63	Professional	TC	$478.63	$478.63	$478.63
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $281.84 / $1,412.54	Professional		$204.17	$281.84	$1,412.54
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $316.23 / $676.08	Professional		$186.21	$316.23	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $151.36	Professional	26	$57.54	$74.13	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $208.93 / $524.81	Professional	TC	$123.03	$208.93	$524.81