Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $67.61 / $354.81	Facility	26	$52.48	$67.61	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $186.21 / $724.44	Professional		$138.04	$186.21	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $95.50 / $302.00	Professional	26	$53.70	$95.50	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $112.20 / $295.12	Professional	TC	$67.61	$112.20	$295.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $123.03 / $309.03	Professional		$77.62	$123.03	$309.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $112.20 / $158.49	Professional	26	$56.23	$112.20	$158.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $229.09 / $562.34	Professional		$134.90	$229.09	$562.34
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $97.72 / $323.59	Professional	26	$56.23	$97.72	$323.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $147.91 / $354.81	Professional	TC	$79.43	$147.91	$354.81
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $204.17 / $436.52	Professional		$138.04	$204.17	$436.52
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $85.11 / $154.88	Professional	26	$63.10	$85.11	$154.88
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $117.49 / $295.12	Professional	TC	$75.86	$117.49	$295.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	26	$16.98	$79.43	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $213.80 / $457.09	Professional		$120.23	$213.80	$457.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $162.18	Professional	26	$50.12	$75.86	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $134.90 / $346.74	Professional	TC	$61.66	$134.90	$346.74
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $154.88 / $208.93	Professional		$112.20	$154.88	$208.93
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $75.86 / $102.33	Professional	26	$48.98	$75.86	$102.33
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $77.62 / $104.71	Professional	TC	$61.66	$77.62	$104.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $151.36 / $275.42	Professional		$120.23	$151.36	$275.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $89.13 / $144.54	Professional	26	$67.61	$89.13	$144.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $87.10 / $147.91	Professional	TC	$64.57	$87.10	$147.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $630.96 / $630.96 / $630.96	Facility	26	$630.96	$630.96	$630.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $1,445.44 / $1,445.44	Professional		$1,445.44	$1,445.44	$1,445.44
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $549.54 / $549.54	Professional	26	$436.52	$549.54	$549.54
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Professional	TC	$1,174.90	$1,174.90	$1,174.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $66.07 / $162.18	Professional		$32.36	$66.07	$162.18
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	26	$16.98	$79.43	$112.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $234.42 / $436.52	Professional		$125.89	$234.42	$436.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $151.36	Professional	26	$50.12	$70.79	$151.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $134.90 / $363.08	Professional	TC	$60.26	$134.90	$363.08
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $501.19 / $501.19	Professional		$501.19	$501.19	$501.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $239.88 / $239.88	Professional	26	$239.88	$239.88	$239.88
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $257.04 / $257.04	Professional	TC	$257.04	$257.04	$257.04
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $144.54 / $190.55	Professional		$112.20	$144.54	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $158.49 / $371.54	Professional		$112.20	$158.49	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $64.57 / $144.54	Professional	26	$41.69	$64.57	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $85.11 / $234.42	Professional	TC	$60.26	$85.11	$234.42