Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.54 / $61.34 / $370.51	Facility	26	$58.54	$61.34	$370.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $179.33 / $268.99 / $1,009.94	Professional		$179.33	$268.99	$1,009.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.27 / $77.28 / $282.73	Professional	26	$57.27	$77.28	$282.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.83 / $201.03 / $558.89	Professional	TC	$108.83	$201.03	$558.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.63 / $179.33 / $283.19	Professional		$104.63	$179.33	$283.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.81 / $60.31 / $136.28	Professional	26	$45.81	$60.31	$136.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $195.68 / $321.91 / $592.23	Professional		$195.68	$321.91	$592.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.29 / $82.19 / $160.87	Professional	26	$57.29	$82.19	$160.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $124.89 / $241.04 / $449.81	Professional	TC	$124.89	$241.04	$449.81
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $145.47 / $222.32 / $559.91	Professional		$145.47	$222.32	$559.91
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.02 / $77.67 / $187.24	Professional	26	$57.02	$77.67	$187.24
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $145.75 / $369.44	Professional	TC	$100.00	$145.75	$369.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.79 / $69.79 / $69.79	Facility	26	$69.79	$69.79	$69.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.62 / $285.37 / $600.26	Professional		$154.62	$285.37	$600.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.85 / $72.38 / $169.62	Professional	26	$36.85	$72.38	$169.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.05 / $214.78 / $457.26	Professional	TC	$101.05	$214.78	$457.26
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $152.34 / $205.93 / $278.01	Professional		$152.34	$205.93	$278.01
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.61 / $67.48 / $91.10	Professional	26	$39.61	$67.48	$91.10
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.73 / $138.44 / $186.91	Professional	TC	$112.73	$138.44	$186.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $161.40 / $208.16 / $348.78	Professional		$161.40	$208.16	$348.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.69 / $80.98 / $141.38	Professional	26	$59.69	$80.98	$141.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $106.78 / $160.16 / $259.69	Professional	TC	$106.78	$160.16	$259.69
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $555.91 / $555.91 / $571.36	Facility	26	$555.91	$555.91	$571.36
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,417.13 / $1,670.68 / $1,670.68	Professional		$1,417.13	$1,670.68	$1,670.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $487.80 / $520.49 / $520.49	Professional	26	$487.80	$520.49	$520.49
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,128.24 / $1,318.41 / $1,318.41	Professional	TC	$1,128.24	$1,318.41	$1,318.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $97.26	Professional		$32.34	$32.34	$97.26
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.79 / $69.79 / $69.79	Facility	26	$69.79	$69.79	$69.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $166.14 / $314.26 / $554.84	Professional		$166.14	$314.26	$554.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.51 / $69.86 / $164.64	Professional	26	$36.51	$69.86	$164.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $101.05 / $214.90 / $435.17	Professional	TC	$101.05	$214.90	$435.17
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $667.70 / $667.70 / $667.70	Professional		$667.70	$667.70	$667.70
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $207.83 / $207.83 / $207.83	Professional	26	$207.83	$207.83	$207.83
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $459.86 / $459.86 / $459.86	Professional	TC	$459.86	$459.86	$459.86
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $166.53 / $228.98 / $516.98	Professional		$166.53	$228.98	$516.98
United Facility/Professional Professional Modifier Low / Median / High Price $173.02 / $234.47 / $536.08	Professional		$173.02	$234.47	$536.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.50 / $65.31 / $158.66	Professional	26	$49.50	$65.31	$158.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.50 / $180.86 / $420.35	Professional	TC	$117.50	$180.86	$420.35