Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.97 / $40.86 / $245.71	Facility	26	$38.97	$40.86	$245.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.62 / $283.07 / $1,365.00	Professional		$229.62	$283.07	$1,365.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.75 / $50.47 / $184.90	Professional	26	$36.75	$50.47	$184.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.87 / $229.93 / $709.49	Professional	TC	$192.87	$229.93	$709.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $235.70 / $270.32 / $382.69	Professional		$235.70	$270.32	$382.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.08 / $64.41 / $89.97	Professional	26	$41.08	$64.41	$89.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $258.98 / $311.77 / $652.66	Professional		$258.98	$311.77	$652.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.50 / $57.40 / $115.52	Professional	26	$44.50	$57.40	$115.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $206.94 / $258.36 / $537.14	Professional	TC	$206.94	$258.36	$537.14
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $207.31 / $320.17 / $691.21	Professional		$207.31	$320.17	$691.21
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $40.49 / $49.37 / $101.54	Professional	26	$40.49	$49.37	$101.54
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $174.66 / $271.99 / $588.89	Professional	TC	$174.66	$271.99	$588.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $217.06 / $324.19 / $813.98	Professional		$217.06	$324.19	$813.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.76 / $51.90 / $115.42	Professional	26	$36.76	$51.90	$115.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.12 / $282.14 / $777.42	Professional	TC	$181.12	$282.14	$777.42
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $141.03 / $351.80 / $474.93	Professional		$141.03	$351.80	$474.93
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.15 / $44.15 / $59.60	Professional	26	$21.15	$44.15	$59.60
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $119.88 / $307.64 / $415.31	Professional	TC	$119.88	$307.64	$415.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $262.08 / $346.61 / $552.86	Professional		$262.08	$346.61	$552.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.32 / $52.89 / $92.76	Professional	26	$36.32	$52.89	$92.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $236.12 / $340.99 / $578.36	Professional	TC	$236.12	$340.99	$578.36
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $203.00 / $225.00	Facility	26	$100.00	$203.00	$225.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,813.42 / $1,813.42 / $2,228.78	Professional		$1,813.42	$1,813.42	$2,228.78
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $328.57 / $328.57 / $328.57	Professional	26	$328.57	$328.57	$328.57
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,562.23 / $1,562.23 / $1,908.45	Professional	TC	$1,562.23	$1,562.23	$1,908.45
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 $215.23 / $318.45 / $773.62	Professional		$215.23	$318.45	$773.62
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.76 / $52.71 / $114.76	Professional	26	$36.76	$52.71	$114.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $180.98 / $281.33 / $777.42	Professional	TC	$180.98	$281.33	$777.42
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,026.38 / $1,026.38 / $1,026.38	Professional		$1,026.38	$1,026.38	$1,026.38
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $138.36 / $138.36 / $138.36	Professional	26	$138.36	$138.36	$138.36
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $888.01 / $888.01 / $888.01	Professional	TC	$888.01	$888.01	$888.01
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $211.55 / $293.27 / $391.25	Professional		$211.55	$293.27	$391.25
United Facility/Professional Professional Modifier Low / Median / High Price $180.59 / $310.61 / $964.63	Professional		$180.59	$310.61	$964.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.19 / $43.67 / $104.36	Professional	26	$33.19	$43.67	$104.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.91 / $264.13 / $865.08	Professional	TC	$148.91	$264.13	$865.08