Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.90 / $58.79 / $290.38	Facility	26	$46.90	$58.79	$290.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.21 / $247.94 / $900.55	Professional		$147.21	$247.94	$900.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.45 / $59.72 / $225.00	Professional	26	$45.45	$59.72	$225.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.65 / $201.03 / $418.36	Professional	TC	$91.65	$201.03	$418.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.80 / $187.24 / $701.47	Professional		$101.80	$187.24	$701.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.88 / $53.35 / $123.53	Professional	26	$34.88	$53.35	$123.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $59.26 / $59.26 / $59.26	Professional	TC	$59.26	$59.26	$59.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $178.34 / $323.23 / $595.90	Professional		$178.34	$323.23	$595.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.59 / $74.27 / $139.71	Professional	26	$51.59	$74.27	$139.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.25 / $248.79 / $449.35	Professional	TC	$121.25	$248.79	$449.35
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $136.96 / $209.76 / $519.07	Professional		$136.96	$209.76	$519.07
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.64 / $65.64 / $151.69	Professional	26	$47.64	$65.64	$151.69
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $145.75 / $368.99	Professional	TC	$100.00	$145.75	$368.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.92 / $267.63 / $516.82	Professional		$125.92	$267.63	$516.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.66 / $62.00 / $137.91	Professional	26	$30.66	$62.00	$137.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $189.21 / $387.09	Professional	TC	$85.11	$189.21	$387.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $124.99 / $169.48 / $228.80	Professional		$124.99	$169.48	$228.80
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.00 / $52.29 / $70.59	Professional	26	$35.00	$52.29	$70.59
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.99 / $117.19 / $158.21	Professional	TC	$89.99	$117.19	$158.21
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $106.81 / $106.81 / $106.81	Professional	26	$106.81	$106.81	$106.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $132.49 / $175.00 / $288.12	Professional		$132.49	$175.00	$288.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.25 / $62.75 / $109.55	Professional	26	$46.25	$62.75	$109.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $90.34 / $135.51 / $219.72	Professional	TC	$90.34	$135.51	$219.72
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $430.56 / $430.56 / $442.24	Facility	26	$430.56	$430.56	$442.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,609.32 / $1,657.60 / $1,657.60	Professional		$1,609.32	$1,657.60	$1,657.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $379.76 / $379.76 / $379.76	Professional	26	$379.76	$379.76	$379.76
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,331.00 / $1,357.90 / $1,357.90	Professional	TC	$1,331.00	$1,357.90	$1,357.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $101.49	Professional		$32.34	$32.34	$101.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $131.33 / $289.99 / $453.77	Professional		$131.33	$289.99	$453.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.76 / $61.20 / $132.12	Professional	26	$29.76	$61.20	$132.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $194.00 / $364.24	Professional	TC	$85.11	$194.00	$364.24
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $518.19 / $518.19 / $518.19	Professional		$518.19	$518.19	$518.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $162.91 / $162.91 / $162.91	Professional	26	$162.91	$162.91	$162.91
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $355.28 / $355.28 / $355.28	Professional	TC	$355.28	$355.28	$355.28
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $137.06 / $188.46 / $567.47	Professional		$137.06	$188.46	$567.47
United Facility/Professional Professional Modifier Low / Median / High Price $134.36 / $203.68 / $447.57	Professional		$134.36	$203.68	$447.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.56 / $56.38 / $121.57	Professional	26	$43.56	$56.38	$121.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.80 / $148.78 / $340.81	Professional	TC	$90.80	$148.78	$340.81