Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.76 / $33.27 / $234.01	Facility	26	$31.76	$33.27	$234.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.04 / $123.53 / $583.00	Professional		$101.04	$123.53	$583.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $45.40 / $173.54	Professional	26	$29.91	$45.40	$173.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.79 / $83.09 / $209.98	Professional	TC	$67.79	$83.09	$209.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.55 / $125.61 / $213.44	Professional		$121.55	$125.61	$213.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.29 / $63.02 / $71.58	Professional	26	$26.29	$63.02	$71.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.77 / $134.79 / $265.02	Professional		$100.77	$134.79	$265.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.72 / $45.77 / $93.11	Professional	26	$36.72	$45.77	$93.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.38 / $88.92 / $178.58	Professional	TC	$64.38	$88.92	$178.58
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $136.53 / $292.69	Professional		$100.00	$136.53	$292.69
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.90 / $40.53 / $100.00	Professional	26	$31.90	$40.53	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $78.81 / $100.00 / $204.08	Professional	TC	$78.81	$100.00	$204.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $43.57 / $43.57	Facility	26	$43.57	$43.57	$43.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.57 / $144.88 / $338.55	Professional		$98.57	$144.88	$338.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.60 / $44.29 / $98.18	Professional	26	$30.60	$44.29	$98.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.76 / $99.42 / $238.17	Professional	TC	$65.76	$99.42	$238.17
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $102.03 / $156.02 / $210.63	Professional		$102.03	$156.02	$210.63
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.59 / $42.50 / $57.38	Professional	26	$29.59	$42.50	$57.38
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $113.52 / $153.25	Professional	TC	$72.44	$113.52	$153.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $118.12 / $155.32 / $261.58	Professional		$118.12	$155.32	$261.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.57 / $51.00 / $79.90	Professional	26	$37.57	$51.00	$79.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $90.82 / $131.27 / $212.84	Professional	TC	$90.82	$131.27	$212.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $187.34 / $187.34	Facility	26	$100.00	$187.34	$187.34
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $812.81 / $812.81 / $1,010.33	Professional		$812.81	$812.81	$1,010.33
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $240.49 / $240.49 / $307.64	Professional	26	$240.49	$240.49	$307.64
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $572.32 / $572.32 / $702.68	Professional	TC	$572.32	$572.32	$702.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $79.56	Professional		$32.34	$32.34	$79.56
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $43.57 / $43.57	Facility	26	$43.57	$43.57	$43.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.81 / $164.10 / $338.73	Professional		$102.81	$164.10	$338.73
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.66 / $43.30 / $92.64	Professional	26	$31.66	$43.30	$92.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $66.88 / $96.25 / $234.38	Professional	TC	$66.88	$96.25	$234.38
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $400.18 / $400.18 / $400.18	Professional		$400.18	$400.18	$400.18
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $131.44 / $131.44 / $131.44	Professional	26	$131.44	$131.44	$131.44
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $268.72 / $268.72 / $268.72	Professional	TC	$268.72	$268.72	$268.72
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $112.97 / $141.94 / $173.49	Professional		$112.97	$141.94	$173.49
United Facility/Professional Professional Modifier Low / Median / High Price $79.64 / $122.34 / $305.39	Professional		$79.64	$122.34	$305.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.83 / $41.50 / $102.18	Professional	26	$26.83	$41.50	$102.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.81 / $82.96 / $231.33	Professional	TC	$52.81	$82.96	$231.33