Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.42 / $63.06 / $534.60	Facility	26	$60.42	$63.06	$534.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.61 / $268.31 / $513.21	Professional		$151.61	$268.31	$513.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.82 / $70.06 / $213.69	Professional	26	$56.82	$70.06	$213.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.29 / $186.96 / $387.01	Professional	TC	$68.29	$186.96	$387.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.33 / $129.26 / $129.26	Professional	26	$72.33	$129.26	$129.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $182.95 / $342.41 / $768.22	Professional		$182.95	$342.41	$768.22
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.80 / $98.75 / $383.56	Professional	26	$66.80	$98.75	$383.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.48 / $256.76 / $569.99	Professional	TC	$80.48	$256.76	$569.99
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $192.41 / $313.22 / $691.03	Professional		$192.41	$313.22	$691.03
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.72 / $69.62 / $173.74	Professional	26	$57.72	$69.62	$173.74
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $147.52 / $244.11 / $525.54	Professional	TC	$147.52	$244.11	$525.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.26 / $105.26 / $105.26	Facility	26	$105.26	$105.26	$105.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.18 / $313.77 / $752.30	Professional		$151.18	$313.77	$752.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.52 / $89.91 / $228.36	Professional	26	$64.52	$89.91	$228.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.45 / $208.18 / $597.75	Professional	TC	$75.45	$208.18	$597.75
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $146.99 / $195.19 / $263.51	Professional		$146.99	$195.19	$263.51
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.04 / $97.60 / $131.76	Professional	26	$47.04	$97.60	$131.76
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.60 / $99.95 / $131.76	Professional	TC	$97.60	$99.95	$131.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $149.09 / $197.15 / $339.78	Professional		$149.09	$197.15	$339.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.84 / $118.18 / $183.49	Professional	26	$87.84	$118.18	$183.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.08 / $112.97 / $183.15	Professional	TC	$78.08	$112.97	$183.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $213.91 / $438.57 / $438.57	Facility	26	$213.91	$438.57	$438.57
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,140.08 / $3,234.28 / $3,234.28	Professional		$3,140.08	$3,234.28	$3,234.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $681.88 / $681.88 / $748.95	Professional	26	$681.88	$681.88	$748.95
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,808.09 / $2,892.33 / $2,892.33	Professional	TC	$2,808.09	$2,892.33	$2,892.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $109.42	Professional		$32.34	$32.34	$109.42
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $105.26 / $105.26 / $105.26	Facility	26	$105.26	$105.26	$105.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $158.47 / $338.47 / $663.79	Professional		$158.47	$338.47	$663.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.86 / $87.11 / $200.27	Professional	26	$64.86	$87.11	$200.27
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $75.45 / $211.62 / $613.16	Professional	TC	$75.45	$211.62	$613.16
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $572.30 / $572.30 / $572.30	Professional		$572.30	$572.30	$572.30
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $305.33 / $305.33 / $305.33	Professional	26	$305.33	$305.33	$305.33
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $266.95 / $266.95 / $266.95	Professional	TC	$266.95	$266.95	$266.95
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $157.72 / $216.87 / $638.64	Professional		$157.72	$216.87	$638.64
United Facility/Professional Professional Modifier Low / Median / High Price $178.28 / $231.12 / $572.09	Professional		$178.28	$231.12	$572.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.44 / $97.80 / $239.80	Professional	26	$51.44	$97.80	$239.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.48 / $142.06 / $376.61	Professional	TC	$80.48	$142.06	$376.61