Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.35 / $134.81 / $795.95	Facility	26	$120.35	$134.81	$795.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $203.03 / $256.43 / $881.00	Professional		$203.03	$256.43	$881.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $118.43 / $135.22 / $509.00	Professional	26	$118.43	$135.22	$509.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.31 / $92.39 / $174.26	Professional	TC	$78.31	$92.39	$174.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $177.21 / $203.88 / $357.16	Professional		$177.21	$203.88	$357.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.84 / $167.38 / $1,022.00	Professional	26	$112.84	$167.38	$1,022.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.36 / $303.45 / $630.45	Professional		$200.36	$303.45	$630.45
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $116.05 / $169.92 / $350.92	Professional	26	$116.05	$169.92	$350.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.87 / $132.61 / $279.52	Professional	TC	$80.87	$132.61	$279.52
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $142.07 / $210.71 / $503.32	Professional		$142.07	$210.71	$503.32
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $141.01 / $206.45	Professional	26	$100.00	$141.01	$206.45
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $86.19 / $112.33 / $180.85	Professional	TC	$86.19	$112.33	$180.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.46 / $294.86 / $665.99	Professional		$185.46	$294.86	$665.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $138.28 / $176.73 / $389.98	Professional	26	$138.28	$176.73	$389.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $99.73 / $132.74 / $304.12	Professional	TC	$99.73	$132.74	$304.12
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $194.55 / $255.72 / $345.22	Professional		$194.55	$255.72	$345.22
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $110.89 / $147.26 / $198.80	Professional	26	$110.89	$147.26	$198.80
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.66 / $108.47 / $146.43	Professional	TC	$83.66	$108.47	$146.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $198.87 / $249.18 / $458.60	Professional		$198.87	$249.18	$458.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $121.56 / $148.80 / $265.80	Professional	26	$121.56	$148.80	$265.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.62 / $108.47 / $195.79	Professional	TC	$83.62	$108.47	$195.79
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $299.41 / $584.34 / $642.01	Facility	26	$299.41	$584.34	$642.01
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,374.92 / $1,374.92 / $1,714.13	Professional		$1,374.92	$1,374.92	$1,714.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $824.31 / $824.31 / $1,042.50	Professional	26	$824.31	$824.31	$1,042.50
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $550.61 / $550.61 / $671.63	Professional	TC	$550.61	$550.61	$671.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $295.02	Professional		$32.34	$32.34	$295.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $233.96 / $331.87 / $582.58	Professional		$233.96	$331.87	$582.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $138.38 / $177.07 / $360.76	Professional	26	$138.38	$177.07	$360.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.03 / $137.49 / $282.51	Professional	TC	$102.03	$137.49	$282.51
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $762.09 / $762.09 / $762.09	Professional		$762.09	$762.09	$762.09
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $440.47 / $440.47 / $440.47	Professional	26	$440.47	$440.47	$440.47
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $321.62 / $321.62 / $321.62	Professional	TC	$321.62	$321.62	$321.62
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $206.78 / $252.92 / $330.74	Professional		$206.78	$252.92	$330.74
United Facility/Professional Professional Modifier Low / Median / High Price $181.72 / $254.40 / $601.85	Professional		$181.72	$254.40	$601.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $106.68 / $147.31 / $373.70	Professional	26	$106.68	$147.31	$373.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.04 / $107.71 / $272.08	Professional	TC	$75.04	$107.71	$272.08