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 / $300.64	Facility	26	$31.76	$33.27	$300.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.45 / $145.77 / $370.07	Professional		$109.45	$145.77	$370.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $51.53 / $152.02	Professional	26	$29.91	$51.53	$152.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.54 / $103.62 / $272.20	Professional	TC	$79.54	$103.62	$272.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.04 / $197.59 / $197.59	Professional		$97.04	$197.59	$197.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.70 / $105.00 / $161.36	Professional	26	$36.70	$105.00	$161.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.85 / $158.84 / $322.91	Professional		$122.85	$158.84	$322.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.72 / $47.08 / $95.13	Professional	26	$36.72	$47.08	$95.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.19 / $112.25 / $230.38	Professional	TC	$80.19	$112.25	$230.38
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $107.47 / $164.03 / $401.68	Professional		$107.47	$164.03	$401.68
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.40 / $40.53 / $100.00	Professional	26	$34.40	$40.53	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $124.53 / $305.91	Professional	TC	$100.00	$124.53	$305.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.98 / $55.98 / $55.98	Facility	26	$55.98	$55.98	$55.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $121.91 / $185.32 / $425.99	Professional		$121.91	$185.32	$425.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.27 / $46.63 / $114.70	Professional	26	$33.27	$46.63	$114.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.95 / $140.49 / $319.77	Professional	TC	$85.95	$140.49	$319.77
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $51.91 / $194.76 / $262.93	Professional		$51.91	$194.76	$262.93
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.42 / $54.16 / $73.12	Professional	26	$11.42	$54.16	$73.12
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.49 / $140.60 / $189.81	Professional	TC	$40.49	$140.60	$189.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $143.34 / $192.80 / $327.90	Professional		$143.34	$192.80	$327.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.92 / $64.98 / $101.82	Professional	26	$47.92	$64.98	$101.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.48 / $162.56 / $263.58	Professional	TC	$112.48	$162.56	$263.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $115.49 / $238.64 / $238.64	Facility	26	$115.49	$238.64	$238.64
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,019.78 / $1,019.78 / $1,259.03	Professional		$1,019.78	$1,019.78	$1,259.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $310.80 / $310.80 / $389.40	Professional	26	$310.80	$310.80	$389.40
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $708.98 / $708.98 / $869.63	Professional	TC	$708.98	$708.98	$869.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $98.21	Professional		$32.34	$32.34	$98.21
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $55.98 / $55.98 / $55.98	Facility	26	$55.98	$55.98	$55.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.38 / $206.05 / $424.99	Professional		$128.38	$206.05	$424.99
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.40 / $45.74 / $100.25	Professional	26	$34.40	$45.74	$100.25
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $85.69 / $136.47 / $309.52	Professional	TC	$85.69	$136.47	$309.52
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $513.17 / $513.17 / $513.17	Professional		$513.17	$513.17	$513.17
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $168.72 / $168.72 / $168.72	Professional	26	$168.72	$168.72	$168.72
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $344.46 / $344.46 / $344.46	Professional	TC	$344.46	$344.46	$344.46
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $77.87 / $157.51 / $216.58	Professional		$77.87	$157.51	$216.58
United Facility/Professional Professional Modifier Low / Median / High Price $108.41 / $161.56 / $418.57	Professional		$108.41	$161.56	$418.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.83 / $53.05 / $125.40	Professional	26	$26.83	$53.05	$125.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.58 / $118.36 / $315.72	Professional	TC	$81.58	$118.36	$315.72