Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $138.04 / $323.59	Facility	26	$51.29	$138.04	$323.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $245.47 / $1,023.29	Professional		$177.83	$245.47	$1,023.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $56.23 / $302.00	Professional	26	$43.65	$56.23	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $177.83 / $630.96	Professional	TC	$131.83	$177.83	$630.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $288.40 / $380.19	Professional		$218.78	$288.40	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $112.20 / $123.03	Professional	26	$83.18	$112.20	$123.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $467.74 / $724.44	Professional		$281.84	$467.74	$724.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $104.71 / $162.18	Professional	26	$67.61	$104.71	$162.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $363.08 / $575.44	Professional	TC	$218.78	$363.08	$575.44
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $363.08 / $676.08	Professional		$257.04	$363.08	$676.08
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $81.28 / $144.54	Professional	26	$57.54	$81.28	$144.54
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $281.84 / $524.81	Professional	TC	$194.98	$281.84	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $85.11	Facility	26	$12.59	$58.88	$85.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $288.40 / $602.56	Professional		$162.18	$288.40	$602.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $66.07 / $131.83	Professional	26	$36.31	$66.07	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $213.80 / $457.09	Professional	TC	$123.03	$213.80	$457.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $263.03 / $354.81	Professional		$199.53	$263.03	$354.81
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $57.54 / $77.62	Professional	26	$43.65	$57.54	$77.62
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $208.93 / $281.84	Professional	TC	$154.88	$208.93	$281.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $251.19 / $512.86	Professional		$194.98	$251.19	$512.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $69.18 / $120.23	Professional	26	$51.29	$69.18	$120.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $239.88 / $398.11	Professional	TC	$173.78	$239.88	$398.11
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $331.13 / $331.13 / $331.13	Facility	26	$331.13	$331.13	$331.13
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,698.24 / $1,698.24	Professional		$1,380.38	$1,698.24	$1,698.24
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $416.87 / $416.87	Professional	26	$331.13	$416.87	$416.87
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,047.13 / $1,288.25 / $1,288.25	Professional	TC	$1,047.13	$1,288.25	$1,288.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $56.23 / $239.88	Professional		$32.36	$56.23	$239.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $85.11	Facility	26	$12.59	$58.88	$85.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $309.03 / $575.44	Professional		$162.18	$309.03	$575.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $60.26 / $120.23	Professional	26	$31.62	$60.26	$120.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $194.98 / $426.58	Professional	TC	$109.65	$194.98	$426.58
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $776.25 / $776.25	Professional		$776.25	$776.25	$776.25
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	26	$181.97	$181.97	$181.97
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $602.56 / $602.56	Professional	TC	$602.56	$602.56	$602.56
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $257.04 / $338.84	Professional		$199.53	$257.04	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $223.87 / $501.19	Professional		$186.21	$223.87	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $53.70 / $114.82	Professional	26	$43.65	$53.70	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $169.82 / $389.05	Professional	TC	$141.25	$169.82	$389.05