Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.67 / $47.26 / $246.26	Facility	26	$38.67	$47.26	$246.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $116.02 / $206.59 / $726.97	Professional		$116.02	$206.59	$726.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.99 / $51.68 / $167.63	Professional	26	$37.99	$51.68	$167.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.01 / $163.43 / $425.25	Professional	TC	$79.01	$163.43	$425.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.06 / $108.48 / $193.95	Professional		$77.06	$108.48	$193.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $41.51 / $90.87	Professional	26	$29.75	$41.51	$90.87
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $47.44 / $63.81 / $63.81	Professional	TC	$47.44	$63.81	$63.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.12 / $248.01 / $456.90	Professional		$128.12	$248.01	$456.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.13 / $54.72 / $106.37	Professional	26	$38.13	$54.72	$106.37
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.34 / $194.61 / $335.29	Professional	TC	$81.34	$194.61	$335.29
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $146.13 / $356.72	Professional		$100.00	$146.13	$356.72
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.95 / $52.29 / $122.71	Professional	26	$37.95	$52.29	$122.71
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $74.91 / $98.05 / $227.94	Professional	TC	$74.91	$98.05	$227.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.92 / $45.92 / $45.92	Facility	26	$45.92	$45.92	$45.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.42 / $201.18 / $386.36	Professional		$98.42	$201.18	$386.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.36 / $49.51 / $112.74	Professional	26	$24.36	$49.51	$112.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.88 / $140.00 / $286.91	Professional	TC	$62.88	$140.00	$286.91
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $101.27 / $138.50 / $186.98	Professional		$101.27	$138.50	$186.98
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.44 / $44.72 / $60.37	Professional	26	$35.44	$44.72	$60.37
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.83 / $93.78 / $126.60	Professional	TC	$65.83	$93.78	$126.60
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $85.10 / $85.10 / $85.10	Professional	26	$85.10	$85.10	$85.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $108.48 / $143.66 / $243.33	Professional		$108.48	$143.66	$243.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.56 / $53.66 / $84.94	Professional	26	$39.56	$53.66	$84.94
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.30 / $108.45 / $175.86	Professional	TC	$72.30	$108.45	$175.86
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $368.56 / $368.56 / $376.16	Facility	26	$368.56	$368.56	$376.16
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $592.41 / $1,305.85 / $1,305.85	Professional		$592.41	$1,305.85	$1,305.85
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $315.37 / $315.37 / $323.39	Professional	26	$315.37	$315.37	$323.39
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,108.00 / $1,108.00 / $1,108.00	Professional	TC	$1,108.00	$1,108.00	$1,108.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $76.77	Professional		$32.34	$32.34	$76.77
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $45.92 / $45.92 / $45.92	Facility	26	$45.92	$45.92	$45.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $98.71 / $221.65 / $335.99	Professional		$98.71	$221.65	$335.99
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.15 / $48.72 / $108.50	Professional	26	$24.15	$48.72	$108.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $62.88 / $146.16 / $276.00	Professional	TC	$62.88	$146.16	$276.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $383.10 / $383.10 / $383.10	Professional		$383.10	$383.10	$383.10
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $138.41 / $138.41 / $138.41	Professional	26	$138.41	$138.41	$138.41
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $244.68 / $244.68 / $244.68	Professional	TC	$244.68	$244.68	$244.68
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $112.00 / $154.00 / $480.00	Professional		$112.00	$154.00	$480.00
United Facility/Professional Professional Modifier Low / Median / High Price $99.70 / $156.81 / $358.52	Professional		$99.70	$156.81	$358.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.90 / $44.83 / $116.81	Professional	26	$32.90	$44.83	$116.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.58 / $114.49 / $249.14	Professional	TC	$62.58	$114.49	$249.14