Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.70 / $138.58 / $449.78	Professional		$103.70	$138.58	$449.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.07 / $79.52 / $416.50	Professional	26	$58.07	$79.52	$416.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.86 / $76.88 / $575.54	Professional	TC	$61.86	$76.88	$575.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $82.98 / $95.35 / $301.29	Professional		$82.98	$95.35	$301.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.15 / $152.38 / $337.65	Professional	26	$33.15	$152.38	$337.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.87 / $50.87 / $456.00	Professional	TC	$50.87	$50.87	$456.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $158.97 / $389.66	Professional		$77.62	$158.97	$389.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $59.40 / $84.82 / $189.30	Professional	26	$59.40	$84.82	$189.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.75 / $74.92 / $210.12	Professional	TC	$20.75	$74.92	$210.12
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $109.70 / $158.07 / $385.33	Professional		$109.70	$158.07	$385.33
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $61.91 / $87.68 / $203.74	Professional	26	$61.91	$87.68	$203.74
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $55.34 / $70.39 / $171.59	Professional	TC	$55.34	$70.39	$171.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $239.70 / $239.70 / $239.70	Facility		$239.70	$239.70	$239.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $73.44 / $97.08 / $299.43	Professional		$73.44	$97.08	$299.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.97 / $42.86 / $141.09	Professional	26	$34.97	$42.86	$141.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.76 / $51.23 / $178.52	Professional	TC	$36.76	$51.23	$178.52
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $51.98 / $219.15 / $295.85	Professional		$51.98	$219.15	$295.85
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.58 / $77.20 / $104.22	Professional	26	$41.58	$77.20	$104.22
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.40 / $141.94 / $191.63	Professional	TC	$10.40	$141.94	$191.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $171.63 / $204.45 / $333.73	Professional		$171.63	$204.45	$333.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.76 / $92.64 / $115.83	Professional	26	$61.76	$92.64	$115.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.90 / $169.91 / $212.93	Professional	TC	$104.90	$169.91	$212.93
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $381.02 / $778.10 / $905.83	Facility		$381.02	$778.10	$905.83
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $160.49 / $305.79 / $336.59	Facility	26	$160.49	$305.79	$336.59
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,961.76 / $1,961.76 / $1,961.76	Professional		$1,961.76	$1,961.76	$1,961.76
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $434.05 / $434.05 / $539.70	Professional	26	$434.05	$434.05	$539.70
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $557.54 / $557.54 / $887.33	Professional	TC	$557.54	$557.54	$887.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $80.22 / $89.45 / $182.61	Professional		$80.22	$89.45	$182.61
Providence Facility/Professional Facility Modifier Low / Median / High Price $96.35 / $193.75 / $283.42	Facility		$96.35	$193.75	$283.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $73.73 / $165.17 / $437.95	Professional		$73.73	$165.17	$437.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $35.32 / $44.93 / $183.11	Professional	26	$35.32	$44.93	$183.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $36.34 / $54.95 / $187.84	Professional	TC	$36.34	$54.95	$187.84
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $584.29 / $584.29 / $584.29	Professional		$584.29	$584.29	$584.29
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $270.12 / $270.12 / $270.12	Professional	26	$270.12	$270.12	$270.12
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $314.18 / $314.18 / $314.18	Professional	TC	$314.18	$314.18	$314.18
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $177.24 / $177.24 / $243.71	Professional		$177.24	$177.24	$243.71
United Facility/Professional Professional Modifier Low / Median / High Price $80.09 / $99.37 / $346.17	Professional		$80.09	$99.37	$346.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.64 / $45.79 / $164.04	Professional	26	$40.64	$45.79	$164.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.65 / $56.53 / $194.13	Professional	TC	$38.65	$56.53	$194.13