Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $154.88 / $354.81	Facility	26	$54.95	$154.88	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $389.05 / $1,513.56	Professional		$229.09	$389.05	$1,513.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $74.13 / $204.17	Professional	26	$52.48	$74.13	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $288.40 / $776.25	Professional	TC	$169.82	$288.40	$776.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $208.93 / $288.40	Professional		$131.83	$208.93	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $46.77 / $107.15	Professional	26	$46.77	$46.77	$107.15
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $524.81 / $912.01	Professional		$331.13	$524.81	$912.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $85.11 / $165.96	Professional	26	$61.66	$85.11	$165.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $436.52 / $776.25	Professional	TC	$269.15	$436.52	$776.25
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $446.68 / $812.83	Professional		$309.03	$446.68	$812.83
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $97.72 / $177.83	Professional	26	$70.79	$97.72	$177.83
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $346.74 / $630.96	Professional	TC	$239.88	$346.74	$630.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $93.33	Facility	26	$14.13	$66.07	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $389.05 / $758.58	Professional		$213.80	$389.05	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $74.13 / $141.25	Professional	26	$40.74	$74.13	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $323.59 / $616.60	Professional	TC	$169.82	$323.59	$616.60
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $316.23 / $426.58	Professional		$234.42	$316.23	$426.58
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $64.57 / $87.10	Professional	26	$52.48	$64.57	$87.10
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $251.19 / $338.84	Professional	TC	$186.21	$251.19	$338.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $323.59 / $602.56	Professional		$245.47	$323.59	$602.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $74.13 / $120.23	Professional	26	$56.23	$74.13	$120.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $295.12 / $512.86	Professional	TC	$223.87	$295.12	$512.86
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $524.81 / $524.81 / $524.81	Facility	26	$524.81	$524.81	$524.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,238.72 / $2,238.72 / $2,238.72	Professional		$2,238.72	$2,238.72	$2,238.72
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $457.09 / $457.09	Professional	26	$436.52	$457.09	$457.09
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Professional	TC	$1,949.84	$1,949.84	$1,949.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $69.18 / $295.12	Professional		$32.36	$69.18	$295.12
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $93.33	Facility	26	$14.13	$66.07	$93.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $426.58 / $724.44	Professional		$213.80	$426.58	$724.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $69.18 / $128.82	Professional	26	$35.48	$69.18	$128.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $302.00 / $562.34	Professional	TC	$169.82	$302.00	$562.34
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $912.01 / $912.01	Professional		$912.01	$912.01	$912.01
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $199.53 / $199.53	Professional	26	$199.53	$199.53	$199.53
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $707.95 / $707.95 / $707.95	Professional	TC	$707.95	$707.95	$707.95
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $354.81 / $616.60	Professional		$257.04	$354.81	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $309.03 / $645.65	Professional		$234.42	$309.03	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.88 / $125.89	Professional	26	$44.67	$58.88	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $251.19 / $512.86	Professional	TC	$181.97	$251.19	$512.86