Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.35 / $91.40 / $525.09	Facility	26	$87.35	$91.40	$525.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $438.48 / $1,565.46	Professional		$275.00	$438.48	$1,565.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.23 / $94.04 / $342.45	Professional	26	$82.23	$94.04	$342.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $176.33 / $351.12 / $762.14	Professional	TC	$176.33	$351.12	$762.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $561.28 / $561.28 / $561.28	Professional		$561.28	$561.28	$561.28
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.86 / $97.12 / $192.10	Professional	26	$64.86	$97.12	$192.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $320.77 / $541.59 / $1,020.49	Professional		$320.77	$541.59	$1,020.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.76 / $108.90 / $220.70	Professional	26	$78.76	$108.90	$220.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $223.52 / $436.24 / $825.49	Professional	TC	$223.52	$436.24	$825.49
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $253.46 / $388.69 / $933.39	Professional		$253.46	$388.69	$933.39
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $80.25 / $108.80 / $264.04	Professional	26	$80.25	$108.80	$264.04
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $180.40 / $280.82 / $661.80	Professional	TC	$180.40	$280.82	$661.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.06 / $98.06 / $98.06	Facility	26	$98.06	$98.06	$98.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $258.52 / $494.55 / $991.58	Professional		$258.52	$494.55	$991.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.65 / $103.87 / $240.40	Professional	26	$52.65	$103.87	$240.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.24 / $365.32 / $761.73	Professional	TC	$186.24	$365.32	$761.73
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $277.18 / $346.68 / $468.02	Professional		$277.18	$346.68	$468.02
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.61 / $94.87 / $128.07	Professional	26	$77.61	$94.87	$128.07
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.57 / $251.82 / $339.96	Professional	TC	$199.57	$251.82	$339.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $296.23 / $400.78 / $712.24	Professional		$296.23	$400.78	$712.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.13 / $113.84 / $180.14	Professional	26	$84.13	$113.84	$180.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $238.13 / $357.20 / $579.19	Professional	TC	$238.13	$357.20	$579.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $785.28 / $785.28 / $801.92	Facility	26	$785.28	$785.28	$801.92
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,101.53 / $3,194.57 / $3,194.57	Professional		$3,101.53	$3,194.57	$3,194.57
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $660.44 / $660.44 / $691.43	Professional	26	$660.44	$660.44	$691.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,625.91 / $2,704.69 / $2,704.69	Professional	TC	$2,625.91	$2,704.69	$2,704.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $214.33	Professional		$32.34	$32.34	$214.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $98.06 / $98.06 / $98.06	Facility	26	$98.06	$98.06	$98.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $273.83 / $561.25 / $923.18	Professional		$273.83	$561.25	$923.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.03 / $100.99 / $225.70	Professional	26	$52.03	$100.99	$225.70
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $189.76 / $365.29 / $733.99	Professional	TC	$189.76	$365.29	$733.99
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,078.71 / $1,078.71 / $1,078.71	Professional		$1,078.71	$1,078.71	$1,078.71
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $294.82 / $294.82 / $294.82	Professional	26	$294.82	$294.82	$294.82
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $783.89 / $783.89 / $783.89	Professional	TC	$783.89	$783.89	$783.89
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $280.37 / $385.51 / $471.20	Professional		$280.37	$385.51	$471.20
United Facility/Professional Professional Modifier Low / Median / High Price $279.16 / $414.54 / $885.34	Professional		$279.16	$414.54	$885.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.90 / $95.50 / $218.19	Professional	26	$73.90	$95.50	$218.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $200.32 / $314.43 / $716.52	Professional	TC	$200.32	$314.43	$716.52