Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $85.11 / $380.19	Facility	26	$61.66	$85.11	$380.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $281.84 / $1,023.29	Professional		$173.78	$281.84	$1,023.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $95.50 / $251.19	Professional	26	$57.54	$95.50	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $199.53 / $549.54	Professional	TC	$107.15	$199.53	$549.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $162.18 / $309.03	Professional		$138.04	$162.18	$309.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $97.72 / $295.12	Professional	26	$50.12	$97.72	$295.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $91.20 / $91.20	Professional	TC	$91.20	$91.20	$91.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $346.74 / $630.96	Professional		$234.42	$346.74	$630.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $89.13 / $173.78	Professional	26	$64.57	$89.13	$173.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $263.03 / $467.74	Professional	TC	$169.82	$263.03	$467.74
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $575.44	Professional		$208.93	$295.12	$575.44
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $102.33 / $186.21	Professional	26	$74.13	$102.33	$186.21
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $199.53 / $389.05	Professional	TC	$134.90	$199.53	$389.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $100.00	Facility	26	$14.79	$69.18	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $288.40 / $524.81	Professional		$162.18	$288.40	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $74.13 / $147.91	Professional	26	$43.65	$74.13	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $208.93 / $389.05	Professional	TC	$107.15	$208.93	$389.05
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $208.93 / $281.84	Professional		$151.36	$208.93	$281.84
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $67.61 / $91.20	Professional	26	$39.81	$67.61	$91.20
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $138.04 / $186.21	Professional	TC	$112.20	$138.04	$186.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $204.17 / $354.81	Professional		$151.36	$204.17	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $77.62 / $128.82	Professional	26	$60.26	$77.62	$128.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $151.36 / $263.03	Professional	TC	$117.49	$151.36	$263.03
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $562.34 / $562.34 / $562.34	Facility	26	$562.34	$562.34	$562.34
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,412.54 / $1,659.59	Professional		$1,412.54	$1,412.54	$1,659.59
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $489.78 / $489.78 / $524.81	Professional	26	$489.78	$489.78	$524.81
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,122.02 / $1,122.02 / $1,318.26	Professional	TC	$1,122.02	$1,122.02	$1,318.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $72.44 / $186.21	Professional		$32.36	$72.44	$186.21
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $100.00	Facility	26	$14.79	$69.18	$100.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $302.00 / $489.78	Professional		$162.18	$302.00	$489.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $67.61 / $131.83	Professional	26	$37.15	$67.61	$131.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $204.17 / $389.05	Professional	TC	$100.00	$204.17	$389.05
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $660.69 / $660.69	Professional		$660.69	$660.69	$660.69
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Professional	26	$208.93	$208.93	$208.93
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $457.09 / $457.09	Professional	TC	$457.09	$457.09	$457.09
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $234.42 / $512.86	Professional		$169.82	$234.42	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $234.42 / $457.09	Professional		$173.78	$234.42	$457.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $131.83	Professional	26	$46.77	$61.66	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $177.83 / $354.81	Professional	TC	$117.49	$177.83	$354.81