Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.47 / $23.38 / $224.60	Facility	26	$21.47	$23.38	$224.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.95 / $219.19 / $802.17	Professional		$182.95	$219.19	$802.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.46 / $35.00 / $101.51	Professional	26	$21.46	$35.00	$101.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.80 / $169.96 / $451.72	Professional	TC	$151.80	$169.96	$451.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $146.26 / $146.26 / $146.26	Professional		$146.26	$146.26	$146.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.38 / $34.36 / $65.47	Professional	26	$32.38	$34.36	$65.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $187.59 / $271.33 / $529.58	Professional		$187.59	$271.33	$529.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.91 / $37.99 / $80.69	Professional	26	$23.91	$37.99	$80.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.52 / $232.07 / $463.38	Professional	TC	$162.52	$232.07	$463.38
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $178.39 / $295.44 / $707.94	Professional		$178.39	$295.44	$707.94
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.84 / $30.18 / $84.10	Professional	26	$23.84	$30.18	$84.10
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $159.85 / $266.45 / $631.59	Professional	TC	$159.85	$266.45	$631.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.28 / $43.28 / $43.28	Facility	26	$43.28	$43.28	$43.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.01 / $307.11 / $629.54	Professional		$204.01	$307.11	$629.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.95 / $44.82 / $105.20	Professional	26	$23.95	$44.82	$105.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $176.29 / $269.97 / $540.88	Professional	TC	$176.29	$269.97	$540.88
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $93.01 / $141.56 / $349.35	Professional		$93.01	$141.56	$349.35
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.53 / $29.72 / $54.86	Professional	26	$19.53	$29.72	$54.86
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.48 / $111.84 / $294.49	Professional	TC	$73.48	$111.84	$294.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $197.83 / $258.77 / $488.71	Professional		$197.83	$258.77	$488.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.35 / $50.80 / $85.95	Professional	26	$36.35	$50.80	$85.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $168.31 / $255.99 / $428.01	Professional	TC	$168.31	$255.99	$428.01
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $87.53 / $169.56 / $181.36	Facility	26	$87.53	$169.56	$181.36
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,546.49 / $1,588.86 / $1,662.38	Professional		$1,546.49	$1,588.86	$1,662.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $391.31 / $391.31 / $391.31	Professional	26	$391.31	$391.31	$391.31
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,356.90 / $1,417.87 / $1,456.72	Professional	TC	$1,356.90	$1,417.87	$1,456.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $215.35	Professional		$32.34	$32.34	$215.35
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.28 / $43.28 / $43.28	Facility	26	$43.28	$43.28	$43.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $208.01 / $334.59 / $589.52	Professional		$208.01	$334.59	$589.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.95 / $43.76 / $97.42	Professional	26	$23.95	$43.76	$97.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $176.09 / $269.97 / $526.72	Professional	TC	$176.09	$269.97	$526.72
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $690.73 / $690.73 / $690.73	Professional		$690.73	$690.73	$690.73
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $128.03 / $128.03 / $128.03	Professional	26	$128.03	$128.03	$128.03
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $562.69 / $562.69 / $562.69	Professional	TC	$562.69	$562.69	$562.69
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $117.97 / $209.26 / $287.74	Professional		$117.97	$209.26	$287.74
United Facility/Professional Professional Modifier Low / Median / High Price $167.53 / $244.88 / $593.87	Professional		$167.53	$244.88	$593.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.20 / $39.03 / $99.68	Professional	26	$22.20	$39.03	$99.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.32 / $211.05 / $491.16	Professional	TC	$131.32	$211.05	$491.16