Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.20 / $36.40 / $222.81	Facility	26	$32.20	$36.40	$222.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.23 / $266.11 / $958.00	Professional		$171.23	$266.11	$958.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.20 / $57.37 / $171.62	Professional	26	$32.20	$57.37	$171.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $140.87 / $222.46 / $929.96	Professional	TC	$140.87	$222.46	$929.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $245.01 / $315.41 / $670.40	Professional		$245.01	$315.41	$670.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.74 / $63.57 / $86.96	Professional	26	$35.74	$63.57	$86.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $196.78 / $257.91 / $558.91	Professional		$196.78	$257.91	$558.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.54 / $46.99 / $94.54	Professional	26	$37.54	$46.99	$94.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $155.96 / $210.92 / $476.34	Professional	TC	$155.96	$210.92	$476.34
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $142.74 / $209.90 / $512.61	Professional		$142.74	$209.90	$512.61
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.84 / $42.03 / $101.24	Professional	26	$34.84	$42.03	$101.24
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $113.92 / $166.80 / $417.63	Professional	TC	$113.92	$166.80	$417.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.66 / $304.45 / $825.30	Professional		$189.66	$304.45	$825.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.97 / $45.23 / $102.92	Professional	26	$31.97	$45.23	$102.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.87 / $267.39 / $725.89	Professional	TC	$154.87	$267.39	$725.89
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $80.14 / $359.96 / $485.95	Professional		$80.14	$359.96	$485.95
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.61 / $43.43 / $58.63	Professional	26	$9.61	$43.43	$58.63
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.52 / $316.54 / $427.33	Professional	TC	$70.52	$316.54	$427.33
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $275.63 / $275.63 / $275.63	Professional		$275.63	$275.63	$275.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $272.92 / $359.96 / $629.34	Professional		$272.92	$359.96	$629.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.27 / $53.65 / $89.49	Professional	26	$37.27	$53.65	$89.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $243.96 / $371.16 / $593.40	Professional	TC	$243.96	$371.16	$593.40
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $95.71 / $463.50 / $463.50	Facility	26	$95.71	$463.50	$463.50
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,395.00 / $2,395.00 / $2,395.00	Professional		$2,395.00	$2,395.00	$2,395.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $719.00 / $719.00 / $719.00	Professional	26	$719.00	$719.00	$719.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,676.00 / $1,676.00 / $1,956.98	Professional	TC	$1,676.00	$1,676.00	$1,956.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $201.30 / $306.69 / $764.46	Professional		$201.30	$306.69	$764.46
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $32.39 / $45.60 / $99.54	Professional	26	$32.39	$45.60	$99.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $154.29 / $267.39 / $679.90	Professional	TC	$154.29	$267.39	$679.90
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $937.95 / $937.95 / $937.95	Professional		$937.95	$937.95	$937.95
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $123.45 / $123.45 / $123.45	Professional	26	$123.45	$123.45	$123.45
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $814.50 / $814.50 / $814.50	Professional	TC	$814.50	$814.50	$814.50
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $120.22 / $206.92 / $400.37	Professional		$120.22	$206.92	$400.37
United Facility/Professional Professional Modifier Low / Median / High Price $139.54 / $354.13 / $852.26	Professional		$139.54	$354.13	$852.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.11 / $48.28 / $136.05	Professional	26	$27.11	$48.28	$136.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.24 / $305.85 / $710.94	Professional	TC	$114.24	$305.85	$710.94