Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.24 / $52.06 / $315.33	Facility	26	$49.24	$52.06	$315.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $150.27 / $246.42 / $832.00	Professional		$150.27	$246.42	$832.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.52 / $60.00 / $206.00	Professional	26	$48.52	$60.00	$206.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.97 / $196.81 / $433.75	Professional	TC	$90.97	$196.81	$433.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.01 / $176.41 / $274.31	Professional		$84.01	$176.41	$274.31
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.95 / $58.21 / $115.89	Professional	26	$37.95	$58.21	$115.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $160.74 / $310.02 / $566.49	Professional		$160.74	$310.02	$566.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.02 / $70.20 / $135.97	Professional	26	$49.02	$70.20	$135.97
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.71 / $240.00 / $416.97	Professional	TC	$100.71	$240.00	$416.97
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $120.21 / $183.61 / $450.04	Professional		$120.21	$183.61	$450.04
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.61 / $66.29 / $159.55	Professional	26	$48.61	$66.29	$159.55
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $93.20 / $118.34 / $285.02	Professional	TC	$93.20	$118.34	$285.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.04 / $59.04 / $59.04	Facility	26	$59.04	$59.04	$59.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $124.05 / $243.69 / $475.65	Professional		$124.05	$243.69	$475.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.29 / $62.42 / $144.38	Professional	26	$31.29	$62.42	$144.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.63 / $161.49 / $354.41	Professional	TC	$78.63	$161.49	$354.41
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $127.59 / $172.33 / $232.65	Professional		$127.59	$172.33	$232.65
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.93 / $56.98 / $76.92	Professional	26	$45.93	$56.98	$76.92
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.66 / $115.35 / $155.72	Professional	TC	$81.66	$115.35	$155.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $135.07 / $175.91 / $305.72	Professional		$135.07	$175.91	$305.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.45 / $68.38 / $119.49	Professional	26	$50.45	$68.38	$119.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $88.92 / $133.38 / $216.29	Professional	TC	$88.92	$133.38	$216.29
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $470.00 / $470.00 / $482.96	Facility	26	$470.00	$470.00	$482.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,593.12 / $1,640.91 / $1,640.91	Professional		$1,593.12	$1,640.91	$1,640.91
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $325.83 / $325.83 / $412.05	Professional	26	$325.83	$325.83	$412.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,318.35 / $1,357.90 / $1,357.90	Professional	TC	$1,318.35	$1,357.90	$1,357.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $95.11	Professional		$32.34	$32.34	$95.11
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $59.04 / $59.04 / $59.04	Facility	26	$59.04	$59.04	$59.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $124.53 / $265.74 / $423.33	Professional		$124.53	$265.74	$423.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.99 / $60.65 / $139.66	Professional	26	$30.99	$60.65	$139.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $77.02 / $173.58 / $343.36	Professional	TC	$77.02	$173.58	$343.36
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $482.87 / $482.87 / $482.87	Professional		$482.87	$482.87	$482.87
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $176.88 / $176.88 / $176.88	Professional	26	$176.88	$176.88	$176.88
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $305.99 / $305.99 / $305.99	Professional	TC	$305.99	$305.99	$305.99
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $139.37 / $191.63 / $567.47	Professional		$139.37	$191.63	$567.47
United Facility/Professional Professional Modifier Low / Median / High Price $125.47 / $191.52 / $427.66	Professional		$125.47	$191.52	$427.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.32 / $55.58 / $130.88	Professional	26	$42.32	$55.58	$130.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.23 / $134.30 / $302.57	Professional	TC	$78.23	$134.30	$302.57