Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.15 / $48.57 / $275.94	Facility	26	$44.15	$48.57	$275.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $187.30 / $219.23 / $467.91	Professional		$187.30	$219.23	$467.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.00 / $49.28 / $222.00	Professional	26	$44.00	$49.28	$222.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.80 / $194.81 / $451.72	Professional	TC	$151.80	$194.81	$451.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.99 / $37.99 / $77.95	Professional	26	$37.99	$37.99	$77.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $236.55 / $310.04 / $617.86	Professional		$236.55	$310.04	$617.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.95 / $65.95 / $132.34	Professional	26	$50.95	$65.95	$132.34
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $183.89 / $242.36 / $506.61	Professional	TC	$183.89	$242.36	$506.61
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $233.57 / $386.82 / $923.63	Professional		$233.57	$386.82	$923.63
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.76 / $63.66 / $148.22	Professional	26	$49.76	$63.66	$148.22
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $194.87 / $324.57 / $775.41	Professional	TC	$194.87	$324.57	$775.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.19 / $52.19 / $52.19	Facility	26	$52.19	$52.19	$52.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $268.95 / $406.61 / $850.43	Professional		$268.95	$406.61	$850.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.54 / $62.19 / $133.31	Professional	26	$47.54	$62.19	$133.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $231.46 / $355.36 / $730.51	Professional	TC	$231.46	$355.36	$730.51
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $195.88 / $298.13 / $459.90	Professional		$195.88	$298.13	$459.90
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.13 / $50.61 / $68.31	Professional	26	$41.13	$50.61	$68.31
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.75 / $235.52 / $391.58	Professional	TC	$154.75	$235.52	$391.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $260.75 / $340.67 / $591.29	Professional		$260.75	$340.67	$591.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.39 / $62.86 / $105.73	Professional	26	$44.39	$62.86	$105.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.63 / $340.20 / $568.80	Professional	TC	$223.63	$340.20	$568.80
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.57 / $202.83 / $221.73	Facility	26	$104.57	$202.83	$221.73
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,904.10 / $1,956.28 / $2,158.73	Professional		$1,904.10	$1,956.28	$2,158.73
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $467.26 / $588.72 / $588.72	Professional	26	$467.26	$588.72	$588.72
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,640.58 / $1,685.53 / $1,797.00	Professional	TC	$1,640.58	$1,685.53	$1,797.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $306.77	Professional		$32.34	$32.34	$306.77
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $52.19 / $52.19 / $52.19	Facility	26	$52.19	$52.19	$52.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $281.14 / $446.78 / $800.20	Professional		$281.14	$446.78	$800.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.54 / $60.87 / $125.57	Professional	26	$47.54	$60.87	$125.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $227.11 / $346.76 / $713.72	Professional	TC	$227.11	$346.76	$713.72
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $916.64 / $916.64 / $916.64	Professional		$916.64	$916.64	$916.64
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $154.38 / $154.38 / $154.38	Professional	26	$154.38	$154.38	$154.38
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $762.25 / $762.25 / $762.25	Professional	TC	$762.25	$762.25	$762.25
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $248.44 / $378.87 / $505.75	Professional		$248.44	$378.87	$505.75
United Facility/Professional Professional Modifier Low / Median / High Price $222.31 / $329.17 / $795.80	Professional		$222.31	$329.17	$795.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $51.65 / $126.44	Professional	26	$37.79	$51.65	$126.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.80 / $277.32 / $696.77	Professional	TC	$177.80	$277.32	$696.77