Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.62 / $56.96 / $1,153.00	Facility	26	$46.62	$56.96	$1,153.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.59 / $247.65 / $931.91	Professional		$107.59	$247.65	$931.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.57 / $63.55 / $248.00	Professional	26	$45.57	$63.55	$248.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.06 / $206.54 / $598.00	Professional	TC	$117.06	$206.54	$598.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.66 / $230.54 / $334.71	Professional		$134.66	$230.54	$334.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.79 / $50.44 / $105.80	Professional	26	$34.79	$50.44	$105.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $80.73 / $131.88 / $131.88	Professional	TC	$80.73	$131.88	$131.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.14 / $305.87 / $564.94	Professional		$186.14	$305.87	$564.94
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.46 / $70.09 / $136.22	Professional	26	$48.46	$70.09	$136.22
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $238.45 / $284.58 / $506.92	Professional	50	$238.45	$284.58	$506.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $127.64 / $238.60 / $428.39	Professional	TC	$127.64	$238.60	$428.39
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $134.09 / $205.52 / $517.91	Professional		$134.09	$205.52	$517.91
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.42 / $61.23 / $144.03	Professional	26	$44.42	$61.23	$144.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $145.75 / $369.44	Professional	TC	$100.00	$145.75	$369.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.13 / $262.27 / $524.97	Professional		$134.13	$262.27	$524.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.99 / $60.00 / $133.16	Professional	26	$28.99	$60.00	$133.16
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $231.34 / $231.34 / $264.19	Professional	50	$231.34	$231.34	$264.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $105.21 / $195.29 / $393.62	Professional	TC	$105.21	$195.29	$393.62
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $158.57 / $202.67 / $273.60	Professional		$158.57	$202.67	$273.60
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.23 / $52.29 / $70.59	Professional	26	$41.23	$52.29	$70.59
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $117.34 / $150.38 / $203.01	Professional	TC	$117.34	$150.38	$203.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $164.67 / $211.85 / $342.15	Professional		$164.67	$211.85	$342.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.25 / $62.75 / $109.55	Professional	26	$46.25	$62.75	$109.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.04 / $184.56 / $299.25	Professional	TC	$123.04	$184.56	$299.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $430.56 / $430.56 / $442.24	Facility	26	$430.56	$430.56	$442.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,378.78 / $1,420.14 / $1,420.14	Professional		$1,378.78	$1,420.14	$1,420.14
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $300.10 / $300.10 / $376.28	Professional	26	$300.10	$300.10	$376.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,103.98 / $1,137.09 / $1,137.09	Professional	TC	$1,103.98	$1,137.09	$1,137.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $133.26	Professional		$32.34	$32.34	$133.26
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $139.93 / $299.72 / $506.35	Professional		$139.93	$299.72	$506.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.81 / $60.00 / $128.52	Professional	26	$28.81	$60.00	$128.52
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $105.21 / $193.68 / $384.15	Professional	TC	$105.21	$193.68	$384.15
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $596.33 / $596.33 / $596.33	Professional		$596.33	$596.33	$596.33
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $162.91 / $162.91 / $162.91	Professional	26	$162.91	$162.91	$162.91
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $433.42 / $433.42 / $433.42	Professional	TC	$433.42	$433.42	$433.42
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $163.91 / $225.38 / $514.84	Professional		$163.91	$225.38	$514.84
United Facility/Professional Professional Modifier Low / Median / High Price $154.30 / $211.26 / $515.78	Professional		$154.30	$211.26	$515.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.60 / $53.96 / $120.60	Professional	26	$41.60	$53.96	$120.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.74 / $156.34 / $340.61	Professional	TC	$110.74	$156.34	$340.61