Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $144.26 / $161.53 / $946.95	Facility	26	$144.26	$161.53	$946.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $236.09 / $281.82 / $1,055.31	Professional		$236.09	$281.82	$1,055.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $141.53 / $161.04 / $459.16	Professional	26	$141.53	$161.04	$459.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.35 / $104.53 / $197.16	Professional	TC	$86.35	$104.53	$197.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $198.42 / $223.72 / $288.74	Professional		$198.42	$223.72	$288.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $135.12 / $188.88 / $337.82	Professional	26	$135.12	$188.88	$337.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.98 / $353.96 / $735.38	Professional		$234.98	$353.96	$735.38
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $140.01 / $202.93 / $419.70	Professional	26	$140.01	$202.93	$419.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $91.50 / $149.76 / $311.94	Professional	TC	$91.50	$149.76	$311.94
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $166.15 / $246.32 / $588.63	Professional		$166.15	$246.32	$588.63
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.12 / $167.32 / $245.29	Professional	26	$117.12	$167.32	$245.29
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $86.78 / $113.10 / $182.09	Professional	TC	$86.78	$113.10	$182.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $214.41 / $340.47 / $757.50	Professional		$214.41	$340.47	$757.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $165.03 / $211.28 / $467.30	Professional	26	$165.03	$211.28	$467.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.00 / $147.22 / $322.35	Professional	TC	$110.00	$147.22	$322.35
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $227.53 / $296.39 / $400.13	Professional		$227.53	$296.39	$400.13
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.97 / $175.84 / $237.38	Professional	26	$131.97	$175.84	$237.38
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.56 / $120.55 / $162.74	Professional	TC	$95.56	$120.55	$162.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $231.07 / $289.52 / $513.48	Professional		$231.07	$289.52	$513.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $145.25 / $177.67 / $317.39	Professional	26	$145.25	$177.67	$317.39
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.99 / $120.55 / $217.59	Professional	TC	$92.99	$120.55	$217.59
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $358.27 / $699.38 / $767.41	Facility	26	$358.27	$699.38	$767.41
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,600.14 / $1,600.14 / $1,997.93	Professional		$1,600.14	$1,600.14	$1,997.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $982.86 / $982.86 / $1,248.83	Professional	26	$982.86	$982.86	$1,248.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $617.27 / $617.27 / $749.18	Professional	TC	$617.27	$617.27	$749.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $345.39	Professional		$32.34	$32.34	$345.39
Providence Facility/Professional Professional Modifier Low / Median / High Price $271.35 / $387.51 / $678.04	Professional		$271.35	$387.51	$678.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $165.89 / $212.13 / $428.44	Professional	26	$165.89	$212.13	$428.44
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $111.91 / $152.06 / $307.00	Professional	TC	$111.91	$152.06	$307.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $870.92 / $870.92 / $870.92	Professional		$870.92	$870.92	$870.92
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $524.61 / $524.61 / $524.61	Professional	26	$524.61	$524.61	$524.61
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $346.31 / $346.31 / $346.31	Professional	TC	$346.31	$346.31	$346.31
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $239.65 / $295.79 / $386.81	Professional		$239.65	$295.79	$386.81
United Facility/Professional Professional Modifier Low / Median / High Price $208.04 / $283.72 / $723.08	Professional		$208.04	$283.72	$723.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $127.12 / $176.68 / $434.33	Professional	26	$127.12	$176.68	$434.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.92 / $118.49 / $300.29	Professional	TC	$80.92	$118.49	$300.29