Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.32 / $103.73 / $608.05	Facility	26	$94.32	$103.73	$608.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $242.65 / $347.32 / $593.44	Professional		$242.65	$347.32	$593.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.56 / $103.73 / $177.90	Professional	26	$90.56	$103.73	$177.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.34 / $253.00 / $397.69	Professional	TC	$149.34	$253.00	$397.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $234.49 / $259.89 / $281.49	Professional		$234.49	$259.89	$281.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $122.97 / $122.97 / $122.97	Professional	26	$122.97	$122.97	$122.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $220.23 / $329.83 / $633.00	Professional		$220.23	$329.83	$633.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $90.38 / $122.22 / $243.94	Professional	26	$90.38	$122.22	$243.94
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $101.49 / $209.90 / $404.53	Professional	TC	$101.49	$209.90	$404.53
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $198.35 / $289.02 / $664.31	Professional		$198.35	$289.02	$664.31
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $66.98 / $92.08 / $222.78	Professional	26	$66.98	$92.08	$222.78
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $134.74 / $192.78 / $440.99	Professional	TC	$134.74	$192.78	$440.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $228.18 / $392.25 / $838.73	Professional		$228.18	$392.25	$838.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.26 / $132.08 / $292.67	Professional	26	$102.26	$132.08	$292.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.41 / $258.27 / $578.98	Professional	TC	$117.41	$258.27	$578.98
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $116.35 / $147.57 / $506.41	Professional		$116.35	$147.57	$506.41
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.87 / $61.98 / $153.06	Professional	26	$48.87	$61.98	$153.06
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.48 / $85.59 / $353.35	Professional	TC	$67.48	$85.59	$353.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $284.18 / $361.18 / $637.70	Professional		$284.18	$361.18	$637.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.69 / $114.57 / $204.65	Professional	26	$93.69	$114.57	$204.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $201.89 / $261.74 / $472.44	Professional	TC	$201.89	$261.74	$472.44
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $232.57 / $451.11 / $495.05	Facility	26	$232.57	$451.11	$495.05
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,013.87 / $2,013.87 / $2,428.35	Professional		$2,013.87	$2,013.87	$2,428.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $716.57 / $716.57 / $802.73	Professional	26	$716.57	$716.57	$802.73
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,590.04 / $1,590.04 / $1,625.63	Professional	TC	$1,590.04	$1,590.04	$1,625.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $402.96	Professional		$32.34	$32.34	$402.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $256.52 / $436.34 / $756.24	Professional		$256.52	$436.34	$756.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $102.26 / $132.72 / $278.39	Professional	26	$102.26	$132.72	$278.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $117.41 / $256.94 / $543.04	Professional	TC	$117.41	$256.94	$543.04
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $853.75 / $853.75 / $853.75	Professional		$853.75	$853.75	$853.75
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $338.49 / $338.49 / $338.49	Professional	26	$338.49	$338.49	$338.49
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $515.25 / $515.25 / $515.25	Professional	TC	$515.25	$515.25	$515.25
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $147.57 / $283.72 / $417.15	Professional		$147.57	$283.72	$417.15
United Facility/Professional Professional Modifier Low / Median / High Price $202.72 / $298.05 / $726.87	Professional		$202.72	$298.05	$726.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.70 / $111.14 / $277.32	Professional	26	$81.70	$111.14	$277.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.40 / $185.19 / $471.13	Professional	TC	$120.40	$185.19	$471.13