Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $75.86 / $165.96	Facility	26	$57.54	$75.86	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $275.42 / $1,023.29	Professional		$162.18	$275.42	$1,023.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $89.13 / $223.87	Professional	26	$57.54	$89.13	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $199.53 / $588.84	Professional	TC	$100.00	$199.53	$588.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $134.90 / $169.82	Professional		$95.50	$134.90	$169.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $97.72 / $138.04	Professional	26	$56.23	$97.72	$138.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $338.84 / $588.84	Professional		$223.87	$338.84	$588.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $91.20 / $173.78	Professional	26	$64.57	$91.20	$173.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $245.47 / $407.38	Professional	TC	$154.88	$245.47	$407.38
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 / $380.19	Professional	TC	$134.90	$199.53	$380.19
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 $141.25 / $263.03 / $478.63	Professional		$141.25	$263.03	$478.63
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 $89.13 / $177.83 / $331.13	Professional	TC	$89.13	$177.83	$331.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $194.98 / $263.03	Professional		$144.54	$194.98	$263.03
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $67.61 / $91.20	Professional	26	$45.71	$67.61	$91.20
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $125.89 / $173.78	Professional	TC	$97.72	$125.89	$173.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $190.55 / $346.74	Professional		$144.54	$190.55	$346.74
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 $107.15 / $138.04 / $239.88	Professional	TC	$107.15	$138.04	$239.88
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 / $1,412.54	Professional		$1,412.54	$1,412.54	$1,412.54
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $389.05 / $489.78 / $489.78	Professional	26	$389.05	$489.78	$489.78
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,318.26 / $1,318.26 / $1,318.26	Professional	TC	$1,318.26	$1,318.26	$1,318.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $72.44 / $177.83	Professional		$32.36	$72.44	$177.83
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 $141.25 / $275.42 / $436.52	Professional		$141.25	$275.42	$436.52
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 $87.10 / $177.83 / $309.03	Professional	TC	$87.10	$177.83	$309.03
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $549.54 / $549.54	Professional		$549.54	$549.54	$549.54
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 $338.84 / $338.84 / $338.84	Professional	TC	$338.84	$338.84	$338.84
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $218.78 / $512.86	Professional		$158.49	$218.78	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $199.53 / $398.11	Professional		$141.25	$199.53	$398.11
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 $87.10 / $141.25 / $281.84	Professional	TC	$87.10	$141.25	$281.84