Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.90 / $55.76 / $290.38	Facility	26	$46.90	$55.76	$290.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $146.43 / $256.77 / $982.97	Professional		$146.43	$256.77	$982.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.88 / $56.90 / $224.40	Professional	26	$44.88	$56.90	$224.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.93 / $201.03 / $418.36	Professional	TC	$97.93	$201.03	$418.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $108.64 / $139.12 / $272.10	Professional		$108.64	$139.12	$272.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.97 / $60.68 / $106.22	Professional	26	$34.97	$60.68	$106.22
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.80 / $58.80 / $58.80	Professional	TC	$58.80	$58.80	$58.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $174.76 / $321.82 / $582.42	Professional		$174.76	$321.82	$582.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.31 / $74.27 / $139.71	Professional	26	$51.31	$74.27	$139.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.25 / $247.40 / $449.35	Professional	TC	$121.25	$247.40	$449.35
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $134.09 / $205.52 / $509.89	Professional		$134.09	$205.52	$509.89
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.42 / $61.23 / $144.03	Professional	26	$44.42	$61.23	$144.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $145.32 / $367.47	Professional	TC	$100.00	$145.32	$367.47
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 $124.97 / $264.36 / $506.35	Professional		$124.97	$264.36	$506.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.76 / $62.00 / $133.16	Professional	26	$29.76	$62.00	$133.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.46 / $187.94 / $385.22	Professional	TC	$84.46	$187.94	$385.22
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $124.34 / $168.56 / $227.56	Professional		$124.34	$168.56	$227.56
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.33 / $52.29 / $70.59	Professional	26	$32.33	$52.29	$70.59
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $92.01 / $116.27 / $156.96	Professional	TC	$92.01	$116.27	$156.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.80 / $174.61 / $284.83	Professional		$131.80	$174.61	$284.83
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 $89.63 / $134.44 / $217.99	Professional	TC	$89.63	$134.44	$217.99
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 $1,345.00 / $1,357.90 / $1,357.90	Professional	TC	$1,345.00	$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 $130.71 / $290.37 / $450.77	Professional		$130.71	$290.37	$450.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.76 / $60.87 / $132.12	Professional	26	$29.76	$60.87	$132.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $84.46 / $193.28 / $363.06	Professional	TC	$84.46	$193.28	$363.06
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $515.78 / $515.78 / $515.78	Professional		$515.78	$515.78	$515.78
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 $352.87 / $352.87 / $352.87	Professional	TC	$352.87	$352.87	$352.87
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $136.33 / $187.45 / $567.47	Professional		$136.33	$187.45	$567.47
United Facility/Professional Professional Modifier Low / Median / High Price $133.75 / $202.01 / $464.40	Professional		$133.75	$202.01	$464.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.50 / $54.80 / $121.89	Professional	26	$41.50	$54.80	$121.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $147.94 / $328.07	Professional	TC	$90.19	$147.94	$328.07