Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.47 / $55.67 / $336.45	Facility	26	$52.47	$55.67	$336.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.02 / $299.57 / $854.62	Professional		$169.02	$299.57	$854.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.08 / $70.14 / $283.50	Professional	26	$50.08	$70.14	$283.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $121.28 / $254.24 / $638.58	Professional	TC	$121.28	$254.24	$638.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $298.60 / $298.60 / $900.46	Professional		$298.60	$298.60	$900.46
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.46 / $66.73 / $123.53	Professional	26	$40.46	$66.73	$123.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $225.82 / $363.40 / $658.47	Professional		$225.82	$363.40	$658.47
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.10 / $74.75 / $145.29	Professional	26	$52.10	$74.75	$145.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.47 / $290.35 / $511.79	Professional	TC	$162.47	$290.35	$511.79
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $187.17 / $286.42 / $676.16	Professional		$187.17	$286.42	$676.16
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.57 / $70.38 / $169.30	Professional	26	$51.57	$70.38	$169.30
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $140.22 / $214.81 / $512.45	Professional	TC	$140.22	$214.81	$512.45
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $157.35 / $304.95 / $616.71	Professional		$157.35	$304.95	$616.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.44 / $67.30 / $153.76	Professional	26	$33.44	$67.30	$153.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.77 / $230.81 / $466.04	Professional	TC	$114.77	$230.81	$466.04
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $161.28 / $218.09 / $294.42	Professional		$161.28	$218.09	$294.42
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.71 / $60.82 / $82.11	Professional	26	$38.71	$60.82	$82.11
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $122.57 / $157.26 / $212.30	Professional	TC	$122.57	$157.26	$212.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $170.07 / $220.47 / $409.59	Professional		$170.07	$220.47	$409.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.80 / $72.98 / $115.53	Professional	26	$53.80	$72.98	$115.53
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 $501.04 / $501.04 / $514.88	Facility	26	$501.04	$501.04	$514.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,638.03 / $1,657.60 / $1,657.60	Professional		$1,638.03	$1,657.60	$1,657.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $376.34 / $376.34 / $438.60	Professional	26	$376.34	$376.34	$438.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,335.34 / $1,357.90 / $1,371.93	Professional	TC	$1,335.34	$1,357.90	$1,371.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $145.24	Professional		$32.34	$32.34	$145.24
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $165.39 / $331.52 / $539.27	Professional		$165.39	$331.52	$539.27
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.13 / $66.33 / $149.05	Professional	26	$33.13	$66.33	$149.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.77 / $231.59 / $439.11	Professional	TC	$114.77	$231.59	$439.11
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $646.01 / $646.01 / $646.01	Professional		$646.01	$646.01	$646.01
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $188.55 / $188.55 / $188.55	Professional	26	$188.55	$188.55	$188.55
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $457.46 / $457.46 / $457.46	Professional	TC	$457.46	$457.46	$457.46
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $176.38 / $242.52 / $611.44	Professional		$176.38	$242.52	$611.44
United Facility/Professional Professional Modifier Low / Median / High Price $167.19 / $244.48 / $558.39	Professional		$167.19	$244.48	$558.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.08 / $60.26 / $142.21	Professional	26	$45.08	$60.26	$142.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.88 / $178.09 / $399.30	Professional	TC	$116.88	$178.09	$399.30