Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.47 / $47.77 / $279.08	Facility	26	$43.47	$47.77	$279.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.49 / $258.55 / $1,312.00	Professional		$190.49	$258.55	$1,312.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.76 / $47.65 / $244.00	Professional	26	$40.76	$47.65	$244.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $148.21 / $209.91 / $964.64	Professional	TC	$148.21	$209.91	$964.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $198.01 / $198.01 / $248.66	Professional		$198.01	$198.01	$248.66
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $239.47 / $328.45 / $669.21	Professional		$239.47	$328.45	$669.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.11 / $64.80 / $134.53	Professional	26	$51.11	$64.80	$134.53
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $187.45 / $265.44 / $534.10	Professional	TC	$187.45	$265.44	$534.10
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $188.04 / $289.77 / $664.47	Professional		$188.04	$289.77	$664.47
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.11 / $55.58 / $118.35	Professional	26	$47.11	$55.58	$118.35
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $151.28 / $235.61 / $546.32	Professional	TC	$151.28	$235.61	$546.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $198.68 / $306.88 / $686.17	Professional		$198.68	$306.88	$686.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.68 / $60.24 / $132.86	Professional	26	$41.68	$60.24	$132.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $176.12 / $259.12 / $571.69	Professional	TC	$176.12	$259.12	$571.69
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $167.77 / $271.11 / $366.00	Professional		$167.77	$271.11	$366.00
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.88 / $50.21 / $67.78	Professional	26	$31.88	$50.21	$67.78
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $135.88 / $220.89 / $298.20	Professional	TC	$135.88	$220.89	$298.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $203.45 / $271.11 / $476.88	Professional		$203.45	$271.11	$476.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.28 / $60.12 / $105.43	Professional	26	$41.28	$60.12	$105.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $169.60 / $244.88 / $415.27	Professional	TC	$169.60	$244.88	$415.27
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $107.73 / $210.21 / $221.68	Facility	26	$107.73	$210.21	$221.68
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,481.01 / $1,525.44 / $1,736.48	Professional		$1,481.01	$1,525.44	$1,736.48
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $501.94 / $501.94 / $501.94	Professional	26	$501.94	$501.94	$501.94
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,231.75 / $1,268.71 / $1,373.85	Professional	TC	$1,231.75	$1,268.71	$1,373.85
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 $197.49 / $299.26 / $679.89	Professional		$197.49	$299.26	$679.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.68 / $60.33 / $129.82	Professional	26	$41.68	$60.33	$129.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $176.12 / $261.74 / $571.69	Professional	TC	$176.12	$261.74	$571.69
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $773.24 / $773.24 / $773.24	Professional		$773.24	$773.24	$773.24
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $157.00 / $157.00 / $157.00	Professional	26	$157.00	$157.00	$157.00
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $616.23 / $616.23 / $616.23	Professional	TC	$616.23	$616.23	$616.23
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $219.26 / $301.49 / $409.11	Professional		$219.26	$301.49	$409.11
United Facility/Professional Professional Modifier Low / Median / High Price $199.70 / $258.43 / $700.01	Professional		$199.70	$258.43	$700.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.72 / $51.66 / $132.41	Professional	26	$38.72	$51.66	$132.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $157.68 / $198.12 / $537.88	Professional	TC	$157.68	$198.12	$537.88