Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $67.61 / $147.91	Facility	26	$52.48	$67.61	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $275.42 / $870.96	Professional		$114.82	$275.42	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $97.72 / $281.84	Professional	26	$52.48	$97.72	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $229.09 / $524.81	Professional	TC	$120.23	$229.09	$524.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $346.74 / $1,000.00	Professional		$302.00	$346.74	$1,000.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $100.00 / $125.89	Professional	26	$52.48	$100.00	$125.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $398.11 / $707.95	Professional		$263.03	$398.11	$707.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $81.28 / $151.36	Professional	26	$57.54	$81.28	$151.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $316.23 / $562.34	Professional	TC	$204.17	$316.23	$562.34
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $380.19 / $691.83	Professional		$269.15	$380.19	$691.83
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $93.33 / $169.82	Professional	26	$67.61	$93.33	$169.82
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $288.40 / $512.86	Professional	TC	$199.53	$288.40	$512.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $302.00 / $562.34	Professional		$162.18	$302.00	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $69.18 / $134.90	Professional	26	$38.90	$69.18	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $229.09 / $426.58	Professional	TC	$114.82	$229.09	$426.58
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $218.78 / $295.12	Professional		$162.18	$218.78	$295.12
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $61.66 / $83.18	Professional	26	$38.90	$61.66	$83.18
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $158.49 / $213.80	Professional	TC	$123.03	$158.49	$213.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $213.80 / $416.87	Professional		$162.18	$213.80	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $114.82	Professional	26	$53.70	$70.79	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $173.78 / $295.12	Professional	TC	$131.83	$173.78	$295.12
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $501.19 / $501.19 / $501.19	Facility	26	$501.19	$501.19	$501.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Professional		$1,659.59	$1,659.59	$1,659.59
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $380.19 / $436.52 / $436.52	Professional	26	$380.19	$436.52	$436.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,348.96 / $1,348.96 / $1,380.38	Professional	TC	$1,348.96	$1,348.96	$1,380.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $66.07 / $208.93	Professional		$32.36	$66.07	$208.93
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $316.23 / $512.86	Professional		$162.18	$316.23	$512.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $64.57 / $120.23	Professional	26	$33.88	$64.57	$120.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $223.87 / $398.11	Professional	TC	$114.82	$223.87	$398.11
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $645.65 / $645.65	Professional		$645.65	$645.65	$645.65
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Professional	26	$190.55	$190.55	$190.55
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $457.09 / $457.09	Professional	TC	$457.09	$457.09	$457.09
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $245.47 / $616.60	Professional		$177.83	$245.47	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $234.42 / $478.63	Professional		$165.96	$234.42	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $56.23 / $117.49	Professional	26	$42.66	$56.23	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $177.83 / $363.08	Professional	TC	$117.49	$177.83	$363.08