Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.42 / $25.55 / $138.38	Facility	26	$23.42	$25.55	$138.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $160.91 / $266.14 / $884.80	Professional		$160.91	$266.14	$884.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.29 / $26.09 / $97.16	Professional	26	$22.29	$26.09	$97.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.77 / $219.60 / $564.78	Professional	TC	$134.77	$219.60	$564.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.90 / $117.90 / $117.90	Professional		$117.90	$117.90	$117.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.12 / $17.12 / $17.12	Professional	26	$17.12	$17.12	$17.12
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $166.17 / $255.86 / $500.26	Professional		$166.17	$255.86	$500.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.74 / $34.45 / $75.04	Professional	26	$23.74	$34.45	$75.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $131.22 / $220.83 / $444.71	Professional	TC	$131.22	$220.83	$444.71
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $160.83 / $265.13 / $628.11	Professional		$160.83	$265.13	$628.11
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.94 / $32.93 / $87.88	Professional	26	$25.94	$32.93	$87.88
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $140.65 / $234.15 / $554.75	Professional	TC	$140.65	$234.15	$554.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $170.67 / $260.33 / $519.12	Professional		$170.67	$260.33	$519.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.19 / $32.93 / $68.47	Professional	26	$25.19	$32.93	$68.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.01 / $231.57 / $472.08	Professional	TC	$151.01	$231.57	$472.08
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $106.42 / $202.46 / $284.94	Professional		$106.42	$202.46	$284.94
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.20 / $32.99 / $49.49	Professional	26	$25.20	$32.99	$49.49
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.43 / $139.69 / $250.92	Professional	TC	$73.43	$139.69	$250.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $161.57 / $211.07 / $397.01	Professional		$161.57	$211.07	$397.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.61 / $31.50 / $53.45	Professional	26	$22.61	$31.50	$53.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $143.38 / $218.08 / $364.64	Professional	TC	$143.38	$218.08	$364.64
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $54.52 / $152.22 / $236.27	Facility	26	$54.52	$152.22	$236.27
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,346.55 / $1,431.47 / $1,470.69	Professional		$1,346.55	$1,431.47	$1,470.69
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $293.89 / $293.89 / $293.89	Professional	26	$293.89	$293.89	$293.89
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,154.84 / $1,288.22 / $1,323.51	Professional	TC	$1,154.84	$1,288.22	$1,323.51
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $183.24	Professional		$32.34	$32.34	$183.24
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $173.83 / $278.81 / $484.95	Professional		$173.83	$278.81	$484.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.19 / $31.87 / $65.50	Professional	26	$25.19	$31.87	$65.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $150.94 / $232.02 / $439.98	Professional	TC	$150.94	$232.02	$439.98
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $548.99 / $548.99 / $548.99	Professional		$548.99	$548.99	$548.99
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $78.86 / $78.86 / $78.86	Professional	26	$78.86	$78.86	$78.86
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $470.13 / $470.13 / $470.13	Professional	TC	$470.13	$470.13	$470.13
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $159.63 / $228.97 / $290.39	Professional		$159.63	$228.97	$290.39
United Facility/Professional Professional Modifier Low / Median / High Price $133.38 / $208.96 / $476.83	Professional		$133.38	$208.96	$476.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.60 / $28.00 / $65.04	Professional	26	$19.60	$28.00	$65.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $113.17 / $181.20 / $409.74	Professional	TC	$113.17	$181.20	$409.74