Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.90 / $62.28 / $229.08	Facility	26	$56.90	$62.28	$229.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $167.13 / $247.87 / $962.33	Professional		$167.13	$247.87	$962.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.72 / $68.98 / $251.14	Professional	26	$40.72	$68.98	$251.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.87 / $169.58 / $317.58	Professional	TC	$111.87	$169.58	$317.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $98.84 / $168.73 / $280.79	Professional		$98.84	$168.73	$280.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.01 / $32.86 / $84.26	Professional	26	$25.01	$32.86	$84.26
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $83.43 / $83.43 / $83.43	Professional	TC	$83.43	$83.43	$83.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $175.59 / $255.43 / $500.62	Professional		$175.59	$255.43	$500.62
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.41 / $71.98 / $132.62	Professional	26	$50.41	$71.98	$132.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.18 / $184.05 / $370.52	Professional	TC	$125.18	$184.05	$370.52
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $168.68 / $274.62 / $644.28	Professional		$168.68	$274.62	$644.28
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.73 / $77.41 / $176.65	Professional	26	$59.73	$77.41	$176.65
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $121.45 / $202.52 / $477.60	Professional	TC	$121.45	$202.52	$477.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.24 / $43.24 / $43.24	Facility	26	$43.24	$43.24	$43.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.70 / $258.33 / $504.99	Professional		$176.70	$258.33	$504.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.72 / $64.95 / $121.61	Professional	26	$41.72	$64.95	$121.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.63 / $198.69 / $393.80	Professional	TC	$134.63	$198.69	$393.80
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $154.72 / $191.65 / $258.73	Professional		$154.72	$191.65	$258.73
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.49 / $41.58 / $56.13	Professional	26	$32.49	$41.58	$56.13
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $122.23 / $150.06 / $202.58	Professional	TC	$122.23	$150.06	$202.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.94 / $206.83 / $390.74	Professional		$158.94	$206.83	$390.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.86 / $51.92 / $87.38	Professional	26	$36.86	$51.92	$87.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.41 / $193.33 / $323.27	Professional	TC	$134.41	$193.33	$323.27
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $88.37 / $251.76 / $251.76	Facility	26	$88.37	$251.76	$251.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,241.41 / $1,354.08 / $1,391.18	Professional		$1,241.41	$1,354.08	$1,391.18
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $315.36 / $335.64 / $344.84	Professional	26	$315.36	$335.64	$344.84
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $934.20 / $1,018.44 / $1,046.33	Professional	TC	$934.20	$1,018.44	$1,046.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $162.59	Professional		$32.34	$32.34	$162.59
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.24 / $43.24 / $43.24	Facility	26	$43.24	$43.24	$43.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $178.58 / $281.36 / $480.00	Professional		$178.58	$281.36	$480.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.29 / $64.98 / $109.49	Professional	26	$43.29	$64.98	$109.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $134.97 / $198.69 / $391.41	Professional	TC	$134.97	$198.69	$391.41
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $549.89 / $549.89 / $549.89	Professional		$549.89	$549.89	$549.89
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $129.05 / $129.05 / $129.05	Professional	26	$129.05	$129.05	$129.05
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $420.84 / $420.84 / $420.84	Professional	TC	$420.84	$420.84	$420.84
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $154.97 / $230.80 / $399.47	Professional		$154.97	$230.80	$399.47
United Facility/Professional Professional Modifier Low / Median / High Price $132.54 / $209.77 / $461.61	Professional		$132.54	$209.77	$461.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.92 / $53.81 / $106.59	Professional	26	$31.92	$53.81	$106.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.28 / $154.99 / $364.88	Professional	TC	$98.28	$154.99	$364.88