Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $70.79 / $147.91	Facility	26	$52.48	$70.79	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $363.08 / $1,380.38	Professional		$234.42	$363.08	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $85.11 / $218.78	Professional	26	$52.48	$85.11	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $251.19 / $575.44	Professional	TC	$173.78	$251.19	$575.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $234.42 / $478.63	Professional		$173.78	$234.42	$478.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $93.33 / $125.89	Professional	26	$44.67	$93.33	$125.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $426.58 / $758.58	Professional		$263.03	$426.58	$758.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $81.28 / $151.36	Professional	26	$57.54	$81.28	$151.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $346.74 / $616.60	Professional	TC	$208.93	$346.74	$616.60
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $380.19 / $707.95	Professional		$269.15	$380.19	$707.95
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $93.33 / $169.82	Professional	26	$67.61	$93.33	$169.82
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $295.12 / $549.54	Professional	TC	$199.53	$295.12	$549.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $331.13 / $645.65	Professional		$181.97	$331.13	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $69.18 / $134.90	Professional	26	$38.90	$69.18	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $263.03 / $512.86	Professional	TC	$144.54	$263.03	$512.86
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $302.00 / $407.38	Professional		$204.17	$302.00	$407.38
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $61.66 / $83.18	Professional	26	$48.98	$61.66	$83.18
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $239.88 / $323.59	Professional	TC	$154.88	$239.88	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $288.40 / $549.54	Professional		$218.78	$288.40	$549.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $114.82	Professional	26	$53.70	$70.79	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $263.03 / $457.09	Professional	TC	$204.17	$263.03	$457.09
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $501.19 / $501.19 / $501.19	Facility	26	$501.19	$501.19	$501.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $1,949.84 / $1,949.84	Professional		$1,862.09	$1,949.84	$1,949.84
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $363.08 / $436.52 / $436.52	Professional	26	$363.08	$436.52	$436.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,584.89 / $1,584.89 / $1,584.89	Professional	TC	$1,584.89	$1,584.89	$1,584.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $66.07 / $269.15	Professional		$32.36	$66.07	$269.15
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $354.81 / $630.96	Professional		$186.21	$354.81	$630.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $64.57 / $120.23	Professional	26	$33.88	$64.57	$120.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $257.04 / $478.63	Professional	TC	$138.04	$257.04	$478.63
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $812.83	Professional		$812.83	$812.83	$812.83
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Professional	26	$190.55	$190.55	$190.55
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $616.60 / $616.60	Professional	TC	$616.60	$616.60	$616.60
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $338.84 / $616.60	Professional		$245.47	$338.84	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $251.19 / $549.54	Professional		$204.17	$251.19	$549.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $56.23 / $117.49	Professional	26	$42.66	$56.23	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $208.93 / $436.52	Professional	TC	$154.88	$208.93	$436.52