Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $59.03 / $348.95	Facility	26	$53.70	$59.03	$348.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.62 / $171.32 / $440.90	Professional		$152.62	$171.32	$440.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.54 / $60.25 / $181.41	Professional	26	$53.54	$60.25	$181.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.29 / $112.26 / $303.82	Professional	TC	$96.29	$112.26	$303.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $281.85 / $281.85 / $281.85	Professional		$281.85	$281.85	$281.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $161.36 / $270.27 / $752.57	Professional		$161.36	$270.27	$752.57
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.05 / $87.58 / $168.07	Professional	26	$58.05	$87.58	$168.07
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $103.77 / $173.32 / $624.83	Professional	TC	$103.77	$173.32	$624.83
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $131.21 / $203.28 / $508.30	Professional		$131.21	$203.28	$508.30
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.63 / $72.15 / $170.67	Professional	26	$57.63	$72.15	$170.67
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $134.43 / $337.94	Professional	TC	$100.00	$134.43	$337.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.70 / $66.70 / $66.70	Facility	26	$66.70	$66.70	$66.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $290.68 / $427.68 / $957.16	Professional		$290.68	$427.68	$957.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.12 / $77.02 / $168.44	Professional	26	$58.12	$77.02	$168.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $231.20 / $352.76 / $788.43	Professional	TC	$231.20	$352.76	$788.43
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $215.90 / $237.49 / $337.32	Professional		$215.90	$237.49	$337.32
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.52 / $88.45 / $134.93	Professional	26	$65.52	$88.45	$134.93
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $134.93 / $161.91 / $203.01	Professional	TC	$134.93	$161.91	$203.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $297.00 / $387.39 / $633.34	Professional		$297.00	$387.39	$633.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.36 / $81.31 / $136.76	Professional	26	$57.36	$81.31	$136.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $248.21 / $377.57 / $631.28	Professional	TC	$248.21	$377.57	$631.28
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $134.77 / $261.89 / $286.66	Facility	26	$134.77	$261.89	$286.66
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,432.95 / $1,731.57 / $1,779.01	Professional		$1,432.95	$1,731.57	$1,779.01
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $367.94 / $367.94 / $467.10	Professional	26	$367.94	$367.94	$467.10
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,115.23 / $1,410.54 / $1,449.19	Professional	TC	$1,115.23	$1,410.54	$1,449.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $360.87	Professional		$32.34	$32.34	$360.87
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $66.70 / $66.70 / $66.70	Facility	26	$66.70	$66.70	$66.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $296.63 / $502.64 / $934.92	Professional		$296.63	$502.64	$934.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.12 / $75.81 / $159.34	Professional	26	$58.12	$75.81	$159.34
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $226.39 / $347.57 / $775.70	Professional	TC	$226.39	$347.57	$775.70
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,047.21 / $1,047.21 / $1,047.21	Professional		$1,047.21	$1,047.21	$1,047.21
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $195.35 / $195.35 / $195.35	Professional	26	$195.35	$195.35	$195.35
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $851.86 / $851.86 / $851.86	Professional	TC	$851.86	$851.86	$851.86
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $174.60 / $240.08 / $404.78	Professional		$174.60	$240.08	$404.78
United Facility/Professional Professional Modifier Low / Median / High Price $244.82 / $336.35 / $948.43	Professional		$244.82	$336.35	$948.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.52 / $65.26 / $165.08	Professional	26	$47.52	$65.26	$165.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $198.80 / $274.62 / $738.50	Professional	TC	$198.80	$274.62	$738.50