Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.50 / $66.14 / $328.13	Facility	26	$59.50	$66.14	$328.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.52 / $372.00 / $1,147.22	Professional		$190.52	$372.00	$1,147.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.37 / $80.36 / $240.05	Professional	26	$55.37	$80.36	$240.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $133.19 / $308.85 / $665.80	Professional	TC	$133.19	$308.85	$665.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $140.51 / $324.58 / $324.58	Professional		$140.51	$324.58	$324.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.75 / $54.98 / $87.97	Professional	26	$39.75	$54.98	$87.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $258.64 / $409.01 / $719.13	Professional		$258.64	$409.01	$719.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.46 / $86.34 / $161.27	Professional	26	$60.46	$86.34	$161.27
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.00 / $330.51 / $547.83	Professional	TC	$190.00	$330.51	$547.83
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $228.81 / $348.19 / $818.22	Professional		$228.81	$348.19	$818.22
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $61.26 / $83.53 / $192.45	Professional	26	$61.26	$83.53	$192.45
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $173.06 / $265.11 / $632.52	Professional	TC	$173.06	$265.11	$632.52
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 $178.15 / $330.00 / $690.00	Professional		$178.15	$330.00	$690.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.70 / $75.09 / $157.04	Professional	26	$37.70	$75.09	$157.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.30 / $261.93 / $541.09	Professional	TC	$131.30	$261.93	$541.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $175.41 / $237.69 / $320.88	Professional		$175.41	$237.69	$320.88
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.10 / $59.31 / $80.06	Professional	26	$42.10	$59.31	$80.06
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $133.31 / $178.38 / $240.81	Professional	TC	$133.31	$178.38	$240.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $180.00 / $240.29 / $445.07	Professional		$180.00	$240.29	$445.07
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 $137.54 / $206.31 / $334.54	Professional	TC	$137.54	$206.31	$334.54
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 $1,657.47 / $1,940.92 / $1,940.92	Professional		$1,657.47	$1,940.92	$1,940.92
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $428.03 / $556.79 / $556.79	Professional	26	$428.03	$556.79	$556.79
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,335.80 / $1,561.11 / $1,561.11	Professional	TC	$1,335.80	$1,561.11	$1,561.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $178.98	Professional		$32.34	$32.34	$178.98
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 $190.75 / $366.73 / $656.02	Professional		$190.75	$366.73	$656.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.39 / $72.40 / $156.79	Professional	26	$37.39	$72.40	$156.79
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $131.30 / $261.93 / $527.52	Professional	TC	$131.30	$261.93	$527.52
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $747.15 / $747.15 / $747.15	Professional		$747.15	$747.15	$747.15
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 $563.25 / $563.25 / $563.25	Professional	TC	$563.25	$563.25	$563.25
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $192.23 / $264.32 / $561.23	Professional		$192.23	$264.32	$561.23
United Facility/Professional Professional Modifier Low / Median / High Price $192.95 / $273.69 / $674.88	Professional		$192.95	$273.69	$674.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $65.59 / $160.05	Professional	26	$49.08	$65.59	$160.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.87 / $213.77 / $482.89	Professional	TC	$143.87	$213.77	$482.89