Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.18 / $55.67 / $336.45	Facility	26	$53.18	$55.67	$336.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $239.78 / $314.75 / $1,315.00	Professional		$239.78	$314.75	$1,315.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $64.37 / $229.01	Professional	26	$51.30	$64.37	$229.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $175.12 / $246.14 / $571.49	Professional	TC	$175.12	$246.14	$571.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $218.28 / $475.27 / $502.89	Professional		$218.28	$475.27	$502.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.46 / $62.07 / $122.98	Professional	26	$40.46	$62.07	$122.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $255.48 / $375.92 / $735.83	Professional		$255.48	$375.92	$735.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.10 / $74.75 / $143.29	Professional	26	$52.10	$74.75	$143.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $199.20 / $301.89 / $580.40	Professional	TC	$199.20	$301.89	$580.40
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $187.17 / $287.63 / $697.71	Professional		$187.17	$287.63	$697.71
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.57 / $70.38 / $169.30	Professional	26	$51.57	$70.38	$169.30
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $140.22 / $218.22 / $526.71	Professional	TC	$140.22	$218.22	$526.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.88 / $334.43 / $711.14	Professional		$166.88	$334.43	$711.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.44 / $67.30 / $153.76	Professional	26	$33.44	$67.30	$153.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $137.12 / $267.66 / $550.38	Professional	TC	$137.12	$267.66	$550.38
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $204.45 / $302.08 / $407.81	Professional		$204.45	$302.08	$407.81
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.07 / $60.82 / $82.11	Professional	26	$49.07	$60.82	$82.11
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $155.38 / $241.26 / $325.70	Professional	TC	$155.38	$241.26	$325.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $220.70 / $298.60 / $513.54	Professional		$220.70	$298.60	$513.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.80 / $72.98 / $127.44	Professional	26	$53.80	$72.98	$127.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $185.97 / $278.95 / $452.34	Professional	TC	$185.97	$278.95	$452.34
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $501.04 / $501.04 / $514.88	Facility	26	$501.04	$501.04	$514.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,817.09 / $1,871.61 / $1,931.70	Professional		$1,817.09	$1,871.61	$1,931.70
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $364.90 / $364.90 / $438.60	Professional	26	$364.90	$364.90	$438.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,526.12 / $1,571.91 / $1,571.91	Professional	TC	$1,526.12	$1,571.91	$1,571.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $203.79	Professional		$32.34	$32.34	$203.79
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $193.07 / $384.06 / $667.31	Professional		$193.07	$384.06	$667.31
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.13 / $66.33 / $149.05	Professional	26	$33.13	$66.33	$149.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $137.12 / $262.14 / $530.54	Professional	TC	$137.12	$262.14	$530.54
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $809.51 / $809.51 / $809.51	Professional		$809.51	$809.51	$809.51
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $188.55 / $188.55 / $188.55	Professional	26	$188.55	$188.55	$188.55
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $620.95 / $620.95 / $620.95	Professional	TC	$620.95	$620.95	$620.95
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $244.33 / $335.95 / $618.24	Professional		$244.33	$335.95	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $208.90 / $275.91 / $679.56	Professional		$208.90	$275.91	$679.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.08 / $60.10 / $144.99	Professional	26	$45.08	$60.10	$144.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.59 / $208.89 / $525.36	Professional	TC	$158.59	$208.89	$525.36