Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.74 / $58.71 / $351.39	Facility	26	$54.74	$58.71	$351.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.38 / $353.52 / $1,093.73	Professional		$199.38	$353.52	$1,093.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $60.72 / $172.83	Professional	26	$52.78	$60.72	$172.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $143.50 / $298.10 / $624.05	Professional	TC	$143.50	$298.10	$624.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.34 / $147.34 / $147.34	Professional		$147.34	$147.34	$147.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.24 / $45.53 / $89.18	Professional	26	$42.24	$45.53	$89.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.64 / $454.75 / $838.79	Professional		$245.64	$454.75	$838.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.69 / $78.34 / $154.29	Professional	26	$54.69	$78.34	$154.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.06 / $376.68 / $669.99	Professional	TC	$181.06	$376.68	$669.99
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $227.68 / $346.73 / $819.31	Professional		$227.68	$346.73	$819.31
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.74 / $73.30 / $174.10	Professional	26	$53.74	$73.30	$174.10
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $178.73 / $273.80 / $652.77	Professional	TC	$178.73	$273.80	$652.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.08 / $368.75 / $771.91	Professional		$185.08	$368.75	$771.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.94 / $68.38 / $161.37	Professional	26	$34.94	$68.38	$161.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $139.91 / $296.06 / $613.75	Professional	TC	$139.91	$296.06	$613.75
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $189.47 / $257.38 / $347.46	Professional		$189.47	$257.38	$347.46
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $63.39 / $85.58	Professional	26	$39.79	$63.39	$85.58
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $149.68 / $193.98 / $261.87	Professional	TC	$149.68	$193.98	$261.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.36 / $259.14 / $444.54	Professional		$194.36	$259.14	$444.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.12 / $76.06 / $123.61	Professional	26	$56.12	$76.06	$123.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $149.56 / $224.34 / $363.77	Professional	TC	$149.56	$224.34	$363.77
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $522.72 / $522.72 / $537.20	Facility	26	$522.72	$522.72	$537.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,019.70 / $2,082.64 / $2,082.64	Professional		$2,019.70	$2,082.64	$2,082.64
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $381.41 / $381.41 / $456.90	Professional	26	$381.41	$381.41	$456.90
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,705.05 / $1,754.89 / $1,802.98	Professional	TC	$1,705.05	$1,754.89	$1,802.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $185.16	Professional		$32.34	$32.34	$185.16
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $197.02 / $404.88 / $679.86	Professional		$197.02	$404.88	$679.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.29 / $65.56 / $160.87	Professional	26	$33.29	$65.56	$160.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $139.91 / $297.55 / $591.54	Professional	TC	$139.91	$297.55	$591.54
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $778.60 / $778.60 / $778.60	Professional		$778.60	$778.60	$778.60
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $197.31 / $197.31 / $197.31	Professional	26	$197.31	$197.31	$197.31
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $581.28 / $581.28 / $581.28	Professional	TC	$581.28	$581.28	$581.28
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $208.16 / $286.22 / $743.34	Professional		$208.16	$286.22	$743.34
United Facility/Professional Professional Modifier Low / Median / High Price $201.24 / $300.68 / $673.84	Professional		$201.24	$300.68	$673.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.30 / $66.34 / $153.66	Professional	26	$47.30	$66.34	$153.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.47 / $236.44 / $556.13	Professional	TC	$148.47	$236.44	$556.13