Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.43 / $56.98 / $345.51	Facility	26	$54.43	$56.98	$345.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $153.44 / $249.83 / $837.90	Professional		$153.44	$249.83	$837.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.28 / $63.33 / $234.00	Professional	26	$51.28	$63.33	$234.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.67 / $195.40 / $490.74	Professional	TC	$91.67	$195.40	$490.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $103.61 / $153.44 / $731.20	Professional		$103.61	$153.44	$731.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.47 / $44.70 / $126.07	Professional	26	$41.47	$44.70	$126.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $160.16 / $311.26 / $575.25	Professional		$160.16	$311.26	$575.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.39 / $76.61 / $148.91	Professional	26	$53.39	$76.61	$148.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $94.20 / $234.54 / $403.93	Professional	TC	$94.20	$234.54	$403.93
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $122.92 / $187.54 / $460.22	Professional		$122.92	$187.54	$460.22
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $52.84 / $72.08 / $173.50	Professional	26	$52.84	$72.08	$173.50
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $91.74 / $116.49 / $280.55	Professional	TC	$91.74	$116.49	$280.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.44 / $64.44 / $64.44	Facility	26	$64.44	$64.44	$64.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.18 / $249.55 / $477.25	Professional		$127.18	$249.55	$477.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.26 / $68.00 / $157.72	Professional	26	$34.26	$68.00	$157.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.40 / $160.75 / $339.54	Professional	TC	$77.40	$160.75	$339.54
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $131.18 / $175.85 / $237.40	Professional		$131.18	$175.85	$237.40
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.85 / $62.34 / $84.16	Professional	26	$49.85	$62.34	$84.16
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.33 / $113.52 / $153.25	Professional	TC	$81.33	$113.52	$153.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.11 / $179.83 / $293.08	Professional		$138.11	$179.83	$293.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.14 / $74.81 / $130.62	Professional	26	$55.14	$74.81	$130.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.51 / $131.27 / $212.84	Professional	TC	$87.51	$131.27	$212.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $513.44 / $513.44 / $527.60	Facility	26	$513.44	$513.44	$527.60
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,561.56 / $1,608.41 / $1,608.41	Professional		$1,561.56	$1,608.41	$1,608.41
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $386.35 / $386.35 / $449.18	Professional	26	$386.35	$386.35	$449.18
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,649.00 / $1,649.00 / $1,649.00	Professional	TC	$1,649.00	$1,649.00	$1,649.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $94.01	Professional		$32.34	$32.34	$94.01
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $64.44 / $64.44 / $64.44	Facility	26	$64.44	$64.44	$64.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $127.79 / $270.72 / $429.84	Professional		$127.79	$270.72	$429.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.92 / $65.98 / $153.51	Professional	26	$33.92	$65.98	$153.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $76.12 / $171.20 / $331.52	Professional	TC	$76.12	$171.20	$331.52
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $495.04 / $495.04 / $495.04	Professional		$495.04	$495.04	$495.04
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $193.85 / $193.85 / $193.85	Professional	26	$193.85	$193.85	$193.85
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $301.18 / $301.18 / $301.18	Professional	TC	$301.18	$301.18	$301.18
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $142.22 / $195.55 / $567.47	Professional		$142.22	$195.55	$567.47
United Facility/Professional Professional Modifier Low / Median / High Price $128.84 / $193.26 / $452.98	Professional		$128.84	$193.26	$452.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.19 / $61.58 / $151.02	Professional	26	$46.19	$61.58	$151.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.00 / $132.72 / $306.57	Professional	TC	$77.00	$132.72	$306.57