Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.42 / $69.63 / $362.64	Facility	26	$54.42	$69.63	$362.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $163.72 / $316.16 / $1,085.00	Professional		$163.72	$316.16	$1,085.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.67 / $76.16 / $237.00	Professional	26	$53.67	$76.16	$237.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.87 / $259.17 / $525.24	Professional	TC	$123.87	$259.17	$525.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.68 / $149.75 / $371.36	Professional		$72.68	$149.75	$371.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.84 / $67.11 / $125.86	Professional	26	$40.84	$67.11	$125.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $51.57 / $107.02 / $238.68	Professional	TC	$51.57	$107.02	$238.68
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $226.26 / $383.77 / $713.08	Professional		$226.26	$383.77	$713.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.39 / $79.88 / $154.61	Professional	26	$55.39	$79.88	$154.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $152.77 / $309.69 / $551.47	Professional	TC	$152.77	$309.69	$551.47
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $189.73 / $290.12 / $692.70	Professional		$189.73	$290.12	$692.70
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.45 / $75.56 / $183.03	Professional	26	$55.45	$75.56	$183.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $139.31 / $213.44 / $505.62	Professional	TC	$139.31	$213.44	$505.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.22 / $323.39 / $620.24	Professional		$158.22	$323.39	$620.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.83 / $70.50 / $162.22	Professional	26	$35.83	$70.50	$162.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.28 / $236.40 / $476.51	Professional	TC	$114.28	$236.40	$476.51
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $160.94 / $218.55 / $295.04	Professional		$160.94	$218.55	$295.04
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.84 / $61.28 / $82.73	Professional	26	$41.84	$61.28	$82.73
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $119.10 / $157.26 / $212.30	Professional	TC	$119.10	$157.26	$212.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $170.42 / $220.93 / $361.66	Professional		$170.42	$220.93	$361.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.16 / $73.54 / $128.29	Professional	26	$54.16	$73.54	$128.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $121.28 / $181.92 / $294.95	Professional	TC	$121.28	$181.92	$294.95
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $504.00 / $504.00 / $518.00	Facility	26	$504.00	$504.00	$518.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $757.95 / $1,947.01 / $1,947.01	Professional		$757.95	$1,947.01	$1,947.01
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $450.76 / $450.76 / $450.76	Professional	26	$450.76	$450.76	$450.76
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,576.92 / $1,624.23 / $1,624.23	Professional	TC	$1,576.92	$1,624.23	$1,624.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $151.06	Professional		$32.34	$32.34	$151.06
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $166.27 / $341.81 / $562.69	Professional		$166.27	$341.81	$562.69
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $35.54 / $69.84 / $154.21	Professional	26	$35.54	$69.84	$154.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.28 / $239.70 / $464.06	Professional	TC	$114.28	$239.70	$464.06
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $653.47 / $653.47 / $653.47	Professional		$653.47	$653.47	$653.47
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $203.22 / $203.22 / $203.22	Professional	26	$203.22	$203.22	$203.22
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $450.25 / $450.25 / $450.25	Professional	TC	$450.25	$450.25	$450.25
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $176.74 / $243.02 / $618.24	Professional		$176.74	$243.02	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $169.33 / $251.45 / $511.16	Professional		$169.33	$251.45	$511.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.12 / $64.16 / $151.10	Professional	26	$48.12	$64.16	$151.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.03 / $183.62 / $409.66	Professional	TC	$115.03	$183.62	$409.66