Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.55 / $38.56 / $201.19	Facility	26	$31.55	$38.56	$201.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.34 / $210.20 / $505.00	Professional		$113.34	$210.20	$505.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $55.33 / $147.88	Professional	26	$29.75	$55.33	$147.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $48.58 / $71.02 / $357.53	Professional	52	$48.58	$71.02	$357.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.59 / $104.09 / $261.64	Professional	TC	$83.59	$104.09	$261.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.62 / $131.35 / $261.39	Professional		$87.62	$131.35	$261.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.31 / $32.38 / $66.70	Professional	26	$24.31	$32.38	$66.70
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $21.90 / $52.85 / $59.46	Professional	52	$21.90	$52.85	$59.46
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $79.95 / $107.98 / $155.57	Professional	TC	$79.95	$107.98	$155.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $116.37 / $145.74 / $296.83	Professional		$116.37	$145.74	$296.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.34 / $45.08 / $93.14	Professional	26	$33.34	$45.08	$93.14
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.54 / $100.16 / $209.67	Professional	TC	$78.54	$100.16	$209.67
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $87.75 / $113.62 / $284.11	Professional		$87.75	$113.62	$284.11
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.93 / $32.11 / $87.94	Professional	26	$24.93	$32.11	$87.94
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $62.81 / $83.76 / $209.44	Professional	TC	$62.81	$83.76	$209.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.99 / $155.16 / $360.89	Professional		$103.99	$155.16	$360.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.04 / $43.56 / $95.43	Professional	26	$30.04	$43.56	$95.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.63 / $114.19 / $267.77	Professional	TC	$72.63	$114.19	$267.77
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $67.65 / $153.06 / $206.63	Professional		$67.65	$153.06	$206.63
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.27 / $36.65 / $49.48	Professional	26	$18.27	$36.65	$49.48
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.38 / $116.41 / $157.15	Professional	TC	$49.38	$116.41	$157.15
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $199.35 / $224.26 / $486.16	Professional		$199.35	$224.26	$486.16
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $137.35 / $141.22 / $141.22	Professional	26	$137.35	$141.22	$141.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.53 / $153.06 / $274.29	Professional		$117.53	$153.06	$274.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $45.67 / $76.84	Professional	26	$32.36	$45.67	$76.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $94.17 / $136.61 / $228.39	Professional	TC	$94.17	$136.61	$228.39
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $148.36 / $161.36	Facility	26	$100.00	$148.36	$161.36
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $778.42 / $778.42 / $987.60	Professional		$778.42	$778.42	$987.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $290.60 / $290.60 / $290.60	Professional	26	$290.60	$290.60	$290.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $570.15 / $570.15 / $723.68	Professional	TC	$570.15	$570.15	$723.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $96.21	Professional		$32.34	$32.34	$96.21
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $105.59 / $165.55 / $346.42	Professional		$105.59	$165.55	$346.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.31 / $42.00 / $92.64	Professional	26	$30.31	$42.00	$92.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $72.31 / $109.81 / $260.17	Professional	TC	$72.31	$109.81	$260.17
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $411.46 / $411.46 / $411.46	Professional		$411.46	$411.46	$411.46
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $112.68 / $112.68 / $112.68	Professional	26	$112.68	$112.68	$112.68
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $298.77 / $298.77 / $298.77	Professional	TC	$298.77	$298.77	$298.77
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $101.48 / $139.26 / $170.20	Professional		$101.48	$139.26	$170.20
United Facility/Professional Professional Modifier Low / Median / High Price $85.26 / $125.23 / $355.90	Professional		$85.26	$125.23	$355.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.76 / $35.36 / $87.98	Professional	26	$24.76	$35.36	$87.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.53 / $89.86 / $230.89	Professional	TC	$60.53	$89.86	$230.89