Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.67 / $53.41 / $324.70	Facility	26	$51.67	$53.41	$324.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.26 / $234.68 / $902.87	Professional		$186.26	$234.68	$902.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.27 / $53.37 / $242.69	Professional	26	$45.27	$53.37	$242.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $139.25 / $166.98 / $565.41	Professional	TC	$139.25	$166.98	$565.41
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $96.03 / $383.48 / $1,085.86	Professional		$96.03	$383.48	$1,085.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $105.29 / $105.29 / $117.47	Professional	26	$105.29	$105.29	$117.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $231.26 / $418.55 / $692.19	Professional		$231.26	$418.55	$692.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.70 / $92.55 / $155.83	Professional	26	$55.70	$92.55	$155.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $173.15 / $323.18 / $537.24	Professional	TC	$173.15	$323.18	$537.24
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $178.05 / $276.08 / $667.54	Professional		$178.05	$276.08	$667.54
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.51 / $61.83 / $143.15	Professional	26	$44.51	$61.83	$143.15
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $137.51 / $215.31 / $520.13	Professional	TC	$137.51	$215.31	$520.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.80 / $59.80 / $59.80	Facility	26	$59.80	$59.80	$59.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $153.08 / $289.50 / $661.81	Professional		$153.08	$289.50	$661.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.52 / $63.97 / $148.66	Professional	26	$30.52	$63.97	$148.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $119.11 / $216.25 / $520.19	Professional	TC	$119.11	$216.25	$520.19
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $199.37 / $264.63 / $357.25	Professional		$199.37	$264.63	$357.25
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.86 / $57.79 / $78.02	Professional	26	$43.86	$57.79	$78.02
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $155.51 / $206.84 / $279.23	Professional	TC	$155.51	$206.84	$279.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.15 / $262.06 / $497.00	Professional		$199.15	$262.06	$497.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.01 / $72.23 / $154.30	Professional	26	$52.01	$72.23	$154.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $168.63 / $248.21 / $388.86	Professional	TC	$168.63	$248.21	$388.86
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $122.98 / $254.79 / $254.79	Facility	26	$122.98	$254.79	$254.79
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,374.92 / $1,374.92 / $1,698.38	Professional		$1,374.92	$1,374.92	$1,698.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $330.16 / $330.16 / $417.45	Professional	26	$330.16	$330.16	$417.45
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,044.76 / $1,044.76 / $1,280.93	Professional	TC	$1,044.76	$1,044.76	$1,280.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $56.28 / $237.43	Professional		$32.34	$56.28	$237.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $59.80 / $59.80 / $59.80	Facility	26	$59.80	$59.80	$59.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $164.19 / $343.06 / $635.41	Professional		$164.19	$343.06	$635.41
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.15 / $62.76 / $147.32	Professional	26	$29.15	$62.76	$147.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $98.27 / $212.43 / $520.19	Professional	TC	$98.27	$212.43	$520.19
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $777.35 / $777.35 / $777.35	Professional		$777.35	$777.35	$777.35
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $181.64 / $181.64 / $181.64	Professional	26	$181.64	$181.64	$181.64
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $595.71 / $595.71 / $595.71	Professional	TC	$595.71	$595.71	$595.71
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $214.02 / $279.11 / $338.92	Professional		$214.02	$279.11	$338.92
United Facility/Professional Professional Modifier Low / Median / High Price $189.28 / $246.69 / $597.45	Professional		$189.28	$246.69	$597.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.91 / $57.02 / $129.78	Professional	26	$44.91	$57.02	$129.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.37 / $187.31 / $460.38	Professional	TC	$144.37	$187.31	$460.38