Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $83.18 / $389.05	Facility	26	$58.88	$83.18	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $302.00 / $1,380.38	Professional		$138.04	$302.00	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $275.42 / $954.99	Professional	26	$57.54	$275.42	$954.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $114.82 / $446.68	Professional	TC	$69.18	$114.82	$446.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $154.88 / $316.23	Professional		$141.25	$154.88	$316.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $89.13 / $144.54	Professional	26	$52.48	$89.13	$144.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $63.10 / $69.18	Professional	TC	$63.10	$63.10	$69.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $239.88 / $467.74	Professional		$165.96	$239.88	$467.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $91.20 / $177.83	Professional	26	$66.07	$91.20	$177.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $151.36 / $281.84	Professional	TC	$97.72	$151.36	$281.84
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $257.04 / $524.81	Professional		$181.97	$257.04	$524.81
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $102.33 / $208.93	Professional	26	$72.44	$102.33	$208.93
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $154.88 / $316.23	Professional	TC	$107.15	$154.88	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $194.98 / $371.54	Professional		$114.82	$194.98	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $77.62 / $158.49	Professional	26	$53.70	$77.62	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $123.03 / $213.80	Professional	TC	$67.61	$123.03	$213.80
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $165.96 / $223.87	Professional		$112.20	$165.96	$223.87
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $70.79 / $95.50	Professional	26	$48.98	$70.79	$95.50
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $93.33 / $125.89	Professional	TC	$63.10	$93.33	$125.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $165.96 / $309.03	Professional		$125.89	$165.96	$309.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $83.18 / $134.90	Professional	26	$61.66	$83.18	$134.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $107.15 / $177.83	Professional	TC	$72.44	$107.15	$177.83
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $380.19 / $380.19 / $380.19	Facility	26	$380.19	$380.19	$380.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,071.52 / $1,071.52	Professional		$1,071.52	$1,071.52	$1,071.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $724.44 / $724.44 / $851.14	Professional	26	$724.44	$724.44	$851.14
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $741.31 / $741.31 / $741.31	Professional	TC	$741.31	$741.31	$741.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $70.79 / $141.25	Professional		$32.36	$70.79	$141.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $199.53 / $354.81	Professional		$112.20	$199.53	$354.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $75.86 / $154.88	Professional	26	$53.70	$75.86	$154.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $123.03 / $213.80	Professional	TC	$64.57	$123.03	$213.80
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $426.58 / $426.58	Professional		$426.58	$426.58	$426.58
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $199.53 / $199.53	Professional	26	$199.53	$199.53	$199.53
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $223.87 / $223.87	Professional	TC	$223.87	$223.87	$223.87
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $186.21 / $316.23	Professional		$134.90	$186.21	$316.23
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $162.18 / $331.13	Professional		$120.23	$162.18	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $77.62 / $147.91	Professional	26	$47.86	$77.62	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $87.10 / $190.55	Professional	TC	$67.61	$87.10	$190.55