Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.11 / $67.15 / $405.27	Facility	26	$64.11	$67.15	$405.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $270.39 / $425.70 / $1,442.00	Professional		$270.39	$425.70	$1,442.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.39 / $79.64 / $262.00	Professional	26	$60.39	$79.64	$262.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.00 / $346.55 / $1,025.66	Professional	TC	$192.00	$346.55	$1,025.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $195.19 / $266.89 / $469.02	Professional		$195.19	$266.89	$469.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.62 / $102.37 / $308.00	Professional	26	$49.62	$102.37	$308.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $501.21 / $890.80	Professional		$275.42	$501.21	$890.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.97 / $90.35 / $175.16	Professional	26	$62.97	$90.35	$175.16
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $204.92 / $413.09 / $734.63	Professional	TC	$204.92	$413.09	$734.63
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $217.13 / $333.48 / $811.19	Professional		$217.13	$333.48	$811.19
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $62.22 / $84.92 / $204.38	Professional	26	$62.22	$84.92	$204.38
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $160.52 / $249.80 / $599.59	Professional	TC	$160.52	$249.80	$599.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.64 / $75.64 / $75.64	Facility	26	$75.64	$75.64	$75.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $224.47 / $416.55 / $837.90	Professional		$224.47	$416.55	$837.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.27 / $81.23 / $185.54	Professional	26	$40.27	$81.23	$185.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.92 / $334.10 / $658.52	Professional	TC	$165.92	$334.10	$658.52
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $237.64 / $324.89 / $438.62	Professional		$237.64	$324.89	$438.62
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.41 / $73.08 / $98.66	Professional	26	$59.41	$73.08	$98.66
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $178.23 / $251.82 / $339.96	Professional	TC	$178.23	$251.82	$339.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $252.06 / $344.64 / $545.63	Professional		$252.06	$344.64	$545.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.68 / $87.70 / $142.51	Professional	26	$64.68	$87.70	$142.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $209.31 / $313.97 / $509.11	Professional	TC	$209.31	$313.97	$509.11
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $602.48 / $602.48 / $619.20	Facility	26	$602.48	$602.48	$619.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,308.83 / $2,385.40 / $2,385.40	Professional		$2,308.83	$2,385.40	$2,385.40
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $533.30 / $533.30 / $533.30	Professional	26	$533.30	$533.30	$533.30
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,603.00 / $2,603.00 / $2,603.00	Professional	TC	$2,603.00	$2,603.00	$2,603.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $229.10	Professional		$32.34	$32.34	$229.10
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $75.64 / $75.64 / $75.64	Facility	26	$75.64	$75.64	$75.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $238.94 / $469.20 / $789.45	Professional		$238.94	$469.20	$789.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.97 / $80.08 / $179.87	Professional	26	$39.97	$80.08	$179.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $165.92 / $331.31 / $623.38	Professional	TC	$165.92	$331.31	$623.38
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $931.11 / $931.11 / $931.11	Professional		$931.11	$931.11	$931.11
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $227.75 / $227.75 / $227.75	Professional	26	$227.75	$227.75	$227.75
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $703.35 / $703.35 / $703.35	Professional	TC	$703.35	$703.35	$703.35
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $262.77 / $361.33 / $618.24	Professional		$262.77	$361.33	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $240.81 / $349.28 / $721.89	Professional		$240.81	$349.28	$721.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.48 / $73.79 / $169.68	Professional	26	$54.48	$73.79	$169.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $179.76 / $271.01 / $617.95	Professional	TC	$179.76	$271.01	$617.95