Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.85 / $55.05 / $385.85	Facility	26	$52.85	$55.05	$385.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.60 / $206.55 / $399.11	Professional		$123.60	$206.55	$399.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.65 / $56.88 / $173.25	Professional	26	$49.65	$56.88	$173.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.99 / $163.68 / $323.37	Professional	TC	$56.99	$163.68	$323.37
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $106.29 / $106.29 / $106.29	Professional		$106.29	$106.29	$106.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.75 / $143.83 / $143.83	Professional	26	$53.75	$143.83	$143.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $142.28 / $282.44 / $633.91	Professional		$142.28	$282.44	$633.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.10 / $80.93 / $258.57	Professional	26	$57.10	$80.93	$258.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.73 / $208.67 / $470.98	Professional	TC	$70.73	$208.67	$470.98
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $157.96 / $256.91 / $567.26	Professional		$157.96	$256.91	$567.26
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.48 / $60.90 / $149.31	Professional	26	$50.48	$60.90	$149.31
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $118.70 / $196.38 / $426.28	Professional	TC	$118.70	$196.38	$426.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.09 / $77.09 / $77.09	Facility	26	$77.09	$77.09	$77.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.77 / $237.67 / $676.72	Professional		$116.77	$237.67	$676.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.64 / $73.75 / $164.23	Professional	26	$51.64	$73.75	$164.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.42 / $152.22 / $550.66	Professional	TC	$64.42	$152.22	$550.66
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $114.98 / $150.22 / $202.81	Professional		$114.98	$150.22	$202.81
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.69 / $69.77 / $94.19	Professional	26	$43.69	$69.77	$94.19
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $71.29 / $80.47 / $108.63	Professional	TC	$71.29	$80.47	$108.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.06 / $151.69 / $261.33	Professional		$117.06	$151.69	$261.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.79 / $84.41 / $131.18	Professional	26	$62.79	$84.41	$131.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $64.38 / $93.08 / $150.93	Professional	TC	$64.38	$93.08	$150.93
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $155.03 / $317.02 / $317.02	Facility	26	$155.03	$317.02	$317.02
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,098.01 / $3,190.96 / $3,190.96	Professional		$3,098.01	$3,190.96	$3,190.96
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $636.41 / $636.41 / $636.41	Professional	26	$636.41	$636.41	$636.41
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,808.09 / $2,892.33 / $2,892.33	Professional	TC	$2,808.09	$2,892.33	$2,892.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $80.43	Professional		$32.34	$32.34	$80.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $77.09 / $77.09 / $77.09	Facility	26	$77.09	$77.09	$77.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $124.46 / $264.69 / $608.22	Professional		$124.46	$264.69	$608.22
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.63 / $71.86 / $152.06	Professional	26	$54.63	$71.86	$152.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $65.40 / $171.18 / $580.48	Professional	TC	$65.40	$171.18	$580.48
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $453.46 / $453.46 / $453.46	Professional		$453.46	$453.46	$453.46
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $222.00 / $222.00 / $222.00	Professional	26	$222.00	$222.00	$222.00
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $231.45 / $231.45 / $231.45	Professional	TC	$231.45	$231.45	$231.45
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $121.36 / $166.87 / $630.07	Professional		$121.36	$166.87	$630.07
United Facility/Professional Professional Modifier Low / Median / High Price $139.99 / $182.87 / $478.76	Professional		$139.99	$182.87	$478.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.08 / $71.81 / $159.25	Professional	26	$45.08	$71.81	$159.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.65 / $107.81 / $376.05	Professional	TC	$69.65	$107.81	$376.05