Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.51 / $54.08 / $328.13	Facility	26	$51.51	$54.08	$328.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $161.91 / $259.95 / $852.01	Professional		$161.91	$259.95	$852.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.57 / $59.10 / $247.77	Professional	26	$48.57	$59.10	$247.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.98 / $208.43 / $431.06	Professional	TC	$104.98	$208.43	$431.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $132.58 / $132.58 / $132.58	Professional		$132.58	$132.58	$132.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.57 / $54.98 / $119.88	Professional	26	$42.57	$54.98	$119.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $179.21 / $319.80 / $591.69	Professional		$179.21	$319.80	$591.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.63 / $72.65 / $141.19	Professional	26	$50.63	$72.65	$141.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $116.97 / $248.84 / $441.33	Professional	TC	$116.97	$248.84	$441.33
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $133.29 / $203.83 / $498.61	Professional		$133.29	$203.83	$498.61
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.18 / $68.44 / $165.11	Professional	26	$50.18	$68.44	$165.11
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $136.46 / $327.56	Professional	TC	$100.00	$136.46	$327.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.08 / $266.79 / $498.45	Professional		$131.08	$266.79	$498.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.19 / $63.60 / $150.31	Professional	26	$32.19	$63.60	$150.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.24 / $187.03 / $380.10	Professional	TC	$88.24	$187.03	$380.10
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $142.83 / $193.16 / $260.77	Professional		$142.83	$193.16	$260.77
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.13 / $59.31 / $80.06	Professional	26	$47.13	$59.31	$80.06
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.70 / $133.86 / $180.71	Professional	TC	$95.70	$133.86	$180.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.08 / $195.58 / $354.57	Professional		$151.08	$195.58	$354.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $71.17 / $124.27	Professional	26	$52.46	$71.17	$124.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $103.24 / $154.86 / $251.09	Professional	TC	$103.24	$154.86	$251.09
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $488.64 / $488.64 / $502.08	Facility	26	$488.64	$488.64	$502.08
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,547.04 / $1,593.45 / $1,593.45	Professional		$1,547.04	$1,593.45	$1,593.45
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $363.24 / $363.24 / $428.03	Professional	26	$363.24	$363.24	$428.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,263.33 / $1,301.23 / $1,301.23	Professional	TC	$1,263.33	$1,301.23	$1,301.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $91.49	Professional		$32.34	$32.34	$91.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $137.97 / $290.55 / $470.36	Professional		$137.97	$290.55	$470.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.14 / $61.51 / $150.22	Professional	26	$31.14	$61.51	$150.22
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $82.48 / $196.13 / $354.21	Professional	TC	$82.48	$196.13	$354.21
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $542.78 / $542.78 / $542.78	Professional		$542.78	$542.78	$542.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $183.89 / $183.89 / $183.89	Professional	26	$183.89	$183.89	$183.89
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $358.88 / $358.88 / $358.88	Professional	TC	$358.88	$358.88	$358.88
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $156.21 / $214.79 / $561.23	Professional		$156.21	$214.79	$561.23
United Facility/Professional Professional Modifier Low / Median / High Price $140.80 / $209.09 / $468.44	Professional		$140.80	$209.09	$468.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.70 / $57.74 / $136.08	Professional	26	$43.70	$57.74	$136.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.72 / $147.94 / $313.26	Professional	TC	$91.72	$147.94	$313.26