Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.24 / $61.04 / $371.01	Facility	26	$58.24	$61.04	$371.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $256.31 / $362.40 / $1,366.00	Professional		$256.31	$362.40	$1,366.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.87 / $75.40 / $258.16	Professional	26	$54.87	$75.40	$258.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $176.19 / $281.72 / $755.22	Professional	TC	$176.19	$281.72	$755.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $222.11 / $250.40 / $416.82	Professional		$222.11	$250.40	$416.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.37 / $59.67 / $113.09	Professional	26	$44.37	$59.67	$113.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $262.17 / $403.19 / $768.20	Professional		$262.17	$403.19	$768.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.96 / $81.72 / $156.83	Professional	26	$56.96	$81.72	$156.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $199.20 / $326.07 / $591.74	Professional	TC	$199.20	$326.07	$591.74
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $190.88 / $293.02 / $712.74	Professional		$190.88	$293.02	$712.74
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.73 / $77.34 / $187.24	Professional	26	$56.73	$77.34	$187.24
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $139.31 / $216.82 / $526.71	Professional	TC	$139.31	$216.82	$526.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $187.30 / $350.21 / $729.10	Professional		$187.30	$350.21	$729.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.65 / $72.89 / $169.18	Professional	26	$36.65	$72.89	$169.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.19 / $269.58 / $569.94	Professional	TC	$144.19	$269.58	$569.94
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $208.76 / $306.10 / $413.24	Professional		$208.76	$306.10	$413.24
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.28 / $66.67 / $90.00	Professional	26	$54.28	$66.67	$90.00
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.47 / $239.43 / $323.23	Professional	TC	$154.47	$239.43	$323.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $224.04 / $303.12 / $503.44	Professional		$224.04	$303.12	$503.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.01 / $80.00 / $139.75	Professional	26	$59.01	$80.00	$139.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $184.56 / $276.83 / $448.91	Professional	TC	$184.56	$276.83	$448.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $549.76 / $549.76 / $565.04	Facility	26	$549.76	$549.76	$565.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,846.75 / $1,902.16 / $1,964.18	Professional		$1,846.75	$1,902.16	$1,964.18
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $444.14 / $444.14 / $482.33	Professional	26	$444.14	$444.14	$482.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,104.00 / $2,104.00 / $2,104.00	Professional	TC	$2,104.00	$2,104.00	$2,104.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $202.68	Professional		$32.34	$32.34	$202.68
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $197.23 / $398.33 / $683.83	Professional		$197.23	$398.33	$683.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.33 / $70.73 / $163.77	Professional	26	$36.33	$70.73	$163.77
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $144.19 / $267.66 / $532.44	Professional	TC	$144.19	$267.66	$532.44
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $826.43 / $826.43 / $826.43	Professional		$826.43	$826.43	$826.43
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $207.88 / $207.88 / $207.88	Professional	26	$207.88	$207.88	$207.88
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $618.54 / $618.54 / $618.54	Professional	TC	$618.54	$618.54	$618.54
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $247.57 / $340.41 / $618.24	Professional		$247.57	$340.41	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $213.50 / $276.30 / $634.58	Professional		$213.50	$276.30	$634.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.22 / $70.56 / $181.01	Professional	26	$49.22	$70.56	$181.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $157.97 / $223.03 / $503.63	Professional	TC	$157.97	$223.03	$503.63