Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.10 / $38.17 / $40.90	Facility	26	$36.10	$38.17	$40.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $263.24 / $299.41 / $948.00	Professional		$263.24	$299.41	$948.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.54 / $38.17 / $68.09	Professional	26	$35.54	$38.17	$68.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.02 / $236.99 / $392.28	Professional	TC	$218.02	$236.99	$392.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $250.74 / $250.74 / $250.74	Professional		$250.74	$250.74	$250.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.59 / $33.59 / $36.32	Professional	26	$33.59	$33.59	$36.32
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $277.38 / $371.72 / $742.19	Professional		$277.38	$371.72	$742.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.81 / $48.98 / $97.80	Professional	26	$38.81	$48.98	$97.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $235.39 / $322.73 / $644.39	Professional	TC	$235.39	$322.73	$644.39
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $203.50 / $328.50 / $788.54	Professional		$203.50	$328.50	$788.54
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $35.75 / $43.12 / $104.01	Professional	26	$35.75	$43.12	$104.01
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $175.69 / $283.62 / $684.81	Professional	TC	$175.69	$283.62	$684.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.98 / $42.98 / $42.98	Facility	26	$42.98	$42.98	$42.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $273.95 / $372.46 / $814.67	Professional		$273.95	$372.46	$814.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.43 / $50.58 / $111.88	Professional	26	$38.43	$50.58	$111.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $236.10 / $318.70 / $702.30	Professional	TC	$236.10	$318.70	$702.30
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $247.34 / $324.82 / $438.51	Professional		$247.34	$324.82	$438.51
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.21 / $52.93 / $247.34	Professional	26	$39.21	$52.93	$247.34
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $247.34 / $285.61 / $385.57	Professional	TC	$247.34	$285.61	$385.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $249.02 / $324.82 / $605.90	Professional		$249.02	$324.82	$605.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.29 / $49.01 / $84.16	Professional	26	$35.29	$49.01	$84.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $231.03 / $335.07 / $560.23	Professional	TC	$231.03	$335.07	$560.23
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $86.46 / $171.05 / $178.55	Facility	26	$86.46	$171.05	$178.55
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,627.28 / $1,627.28 / $2,088.23	Professional		$1,627.28	$1,627.28	$2,088.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $234.31 / $234.31 / $315.52	Professional	26	$234.31	$234.31	$315.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,392.98 / $1,392.98 / $1,772.70	Professional	TC	$1,392.98	$1,392.98	$1,772.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $282.38	Professional		$32.34	$32.34	$282.38
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $42.98 / $42.98 / $42.98	Facility	26	$42.98	$42.98	$42.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $283.66 / $425.01 / $767.15	Professional		$283.66	$425.01	$767.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.76 / $49.53 / $100.81	Professional	26	$38.76	$49.53	$100.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $238.73 / $313.27 / $689.65	Professional	TC	$238.73	$313.27	$689.65
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $894.54 / $894.54 / $894.54	Professional		$894.54	$894.54	$894.54
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $123.22 / $123.22 / $123.22	Professional	26	$123.22	$123.22	$123.22
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $771.31 / $771.31 / $771.31	Professional	TC	$771.31	$771.31	$771.31
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $262.64 / $346.27 / $420.47	Professional		$262.64	$346.27	$420.47
United Facility/Professional Professional Modifier Low / Median / High Price $210.84 / $301.19 / $753.13	Professional		$210.84	$301.19	$753.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.80 / $43.40 / $98.25	Professional	26	$30.80	$43.40	$98.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $180.04 / $261.70 / $702.74	Professional	TC	$180.04	$261.70	$702.74