Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.18 / $55.67 / $336.45	Facility	26	$53.18	$55.67	$336.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $200.73 / $303.70 / $981.06	Professional		$200.73	$303.70	$981.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $60.00 / $284.00	Professional	26	$50.07	$60.00	$284.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.72 / $251.41 / $669.15	Professional	TC	$152.72	$251.41	$669.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.46 / $53.63 / $110.80	Professional	26	$40.46	$53.63	$110.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $231.98 / $365.40 / $671.00	Professional		$231.98	$365.40	$671.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.10 / $74.75 / $145.29	Professional	26	$52.10	$74.75	$145.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $174.45 / $290.86 / $536.91	Professional	TC	$174.45	$290.86	$536.91
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $184.48 / $283.45 / $687.63	Professional		$184.48	$283.45	$687.63
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.57 / $70.38 / $169.30	Professional	26	$51.57	$70.38	$169.30
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $137.53 / $214.04 / $512.28	Professional	TC	$137.53	$214.04	$512.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.96 / $312.36 / $652.53	Professional		$166.96	$312.36	$652.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.44 / $67.30 / $153.76	Professional	26	$33.44	$67.30	$153.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $130.66 / $246.90 / $495.04	Professional	TC	$130.66	$246.90	$495.04
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $196.77 / $264.44 / $356.99	Professional		$196.77	$264.44	$356.99
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.19 / $60.82 / $82.11	Professional	26	$49.19	$60.82	$82.11
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.58 / $203.62 / $274.89	Professional	TC	$147.58	$203.62	$274.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.28 / $264.44 / $449.55	Professional		$199.28	$264.44	$449.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.80 / $72.98 / $127.44	Professional	26	$53.80	$72.98	$127.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $156.97 / $235.47 / $381.82	Professional	TC	$156.97	$235.47	$381.82
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $501.04 / $501.04 / $514.88	Facility	26	$501.04	$501.04	$514.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,627.19 / $1,657.60 / $1,699.73	Professional		$1,627.19	$1,657.60	$1,699.73
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $345.18 / $345.18 / $438.60	Professional	26	$345.18	$345.18	$438.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,330.47 / $1,357.90 / $1,366.92	Professional	TC	$1,330.47	$1,357.90	$1,366.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $142.15	Professional		$32.34	$32.34	$142.15
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $174.16 / $365.34 / $615.44	Professional		$174.16	$365.34	$615.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.13 / $66.38 / $147.96	Professional	26	$33.13	$66.38	$147.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $130.66 / $237.54 / $485.55	Professional	TC	$130.66	$237.54	$485.55
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $743.39 / $743.39 / $743.39	Professional		$743.39	$743.39	$743.39
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $188.55 / $188.55 / $188.55	Professional	26	$188.55	$188.55	$188.55
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $554.83 / $554.83 / $554.83	Professional	TC	$554.83	$554.83	$554.83
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $213.88 / $294.08 / $611.44	Professional		$213.88	$294.08	$611.44
United Facility/Professional Professional Modifier Low / Median / High Price $192.03 / $248.51 / $577.73	Professional		$192.03	$248.51	$577.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.08 / $59.19 / $139.51	Professional	26	$45.08	$59.19	$139.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.72 / $199.50 / $455.65	Professional	TC	$141.72	$199.50	$455.65