Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.13 / $55.62 / $288.39	Facility	26	$45.13	$55.62	$288.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.46 / $214.48 / $626.03	Professional		$117.46	$214.48	$626.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $75.15 / $247.50	Professional	26	$42.60	$75.15	$247.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.34 / $85.28 / $337.00	Professional	TC	$71.34	$85.28	$337.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $108.48 / $122.65 / $224.98	Professional		$108.48	$122.65	$224.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.99 / $50.40 / $95.34	Professional	26	$34.99	$50.40	$95.34
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $59.33 / $107.95 / $107.95	Professional	TC	$59.33	$107.95	$107.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.91 / $163.01 / $338.73	Professional		$120.91	$163.01	$338.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.54 / $62.83 / $126.40	Professional	26	$48.54	$62.83	$126.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.61 / $101.06 / $211.56	Professional	TC	$72.61	$101.06	$211.56
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $144.54 / $349.24	Professional		$100.00	$144.54	$349.24
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.11 / $55.16 / $126.68	Professional	26	$44.11	$55.16	$126.68
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $71.02 / $94.33 / $221.81	Professional	TC	$71.02	$94.33	$221.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.62 / $53.62 / $53.62	Facility	26	$53.62	$53.62	$53.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.24 / $165.84 / $360.41	Professional		$106.24	$165.84	$360.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.65 / $62.56 / $136.36	Professional	26	$42.65	$62.56	$136.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.69 / $103.33 / $225.89	Professional	TC	$63.69	$103.33	$225.89
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $78.42 / $148.01 / $199.81	Professional		$78.42	$148.01	$199.81
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.58 / $52.40 / $70.73	Professional	26	$30.58	$52.40	$70.73
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.84 / $95.62 / $129.09	Professional	TC	$47.84	$95.62	$129.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.74 / $150.00 / $282.00	Professional		$109.74	$150.00	$282.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.28 / $65.29 / $109.85	Professional	26	$46.28	$65.29	$109.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $76.50 / $112.14 / $187.50	Professional	TC	$76.50	$112.14	$187.50
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $111.13 / $211.96 / $230.61	Facility	26	$111.13	$211.96	$230.61
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $757.96 / $757.96 / $968.93	Professional		$757.96	$757.96	$968.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $312.14 / $322.45 / $376.50	Professional	26	$312.14	$322.45	$376.50
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $470.82 / $484.95 / $592.35	Professional	TC	$470.82	$484.95	$592.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $95.20	Professional		$32.34	$32.34	$95.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $53.62 / $53.62 / $53.62	Facility	26	$53.62	$53.62	$53.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $111.39 / $185.20 / $352.12	Professional		$111.39	$185.20	$352.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.54 / $60.18 / $133.76	Professional	26	$43.54	$60.18	$133.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $62.88 / $100.13 / $221.80	Professional	TC	$62.88	$100.13	$221.80
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $406.44 / $406.44 / $406.44	Professional		$406.44	$406.44	$406.44
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $161.75 / $161.75 / $161.75	Professional	26	$161.75	$161.75	$161.75
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $244.68 / $244.68 / $244.68	Professional	TC	$244.68	$244.68	$244.68
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $101.95 / $126.37 / $164.59	Professional		$101.95	$126.37	$164.59
United Facility/Professional Professional Modifier Low / Median / High Price $95.69 / $125.64 / $326.82	Professional		$95.69	$125.64	$326.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.96 / $50.89 / $139.50	Professional	26	$34.96	$50.89	$139.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.07 / $73.76 / $213.24	Professional	TC	$58.07	$73.76	$213.24