Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $39.81 / $89.13	Facility	26	$30.90	$39.81	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $208.93 / $489.78	Professional		$112.20	$208.93	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $58.88 / $141.25	Professional	26	$30.90	$58.88	$141.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $56.23 / $169.82 / $354.81	Professional	52	$56.23	$169.82	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $117.49 / $302.00	Professional	TC	$77.62	$117.49	$302.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $125.89 / $251.19	Professional		$97.72	$125.89	$251.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $47.86 / $85.11	Professional	26	$28.84	$47.86	$85.11
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $18.62 / $22.91 / $52.48	Professional	52	$18.62	$22.91	$52.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $114.82 / $186.21	Professional	TC	$72.44	$114.82	$186.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $147.91 / $302.00	Professional		$114.82	$147.91	$302.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $47.86 / $89.13	Professional	26	$33.88	$47.86	$89.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $97.72 / $218.78	Professional	TC	$75.86	$97.72	$218.78
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $147.91 / $302.00	Professional		$97.72	$147.91	$302.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $40.74 / $87.10	Professional	26	$27.54	$40.74	$87.10
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $104.71 / $223.87	Professional	TC	$69.18	$104.71	$223.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $53.70	Facility	26	$7.94	$37.15	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $151.36 / $295.12	Professional		$100.00	$151.36	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $43.65 / $83.18	Professional	26	$29.51	$43.65	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $109.65 / $229.09	Professional	TC	$69.18	$109.65	$229.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $158.49 / $213.80	Professional		$67.61	$158.49	$213.80
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $37.15 / $50.12	Professional	26	$18.20	$37.15	$50.12
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $120.23 / $162.18	Professional	TC	$48.98	$120.23	$162.18
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $489.78	Professional		$489.78	$489.78	$489.78
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $138.04 / $138.04	Professional	26	$138.04	$138.04	$138.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $147.91 / $251.19	Professional		$114.82	$147.91	$251.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $44.67 / $77.62	Professional	26	$33.11	$44.67	$77.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $134.90 / $229.09	Professional	TC	$95.50	$134.90	$229.09
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	26	$208.93	$208.93	$208.93
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $776.25 / $977.24	Professional		$158.49	$776.25	$977.24
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	26	$288.40	$288.40	$288.40
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $724.44 / $724.44	Professional	TC	$575.44	$724.44	$724.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $95.50 / $134.90	Professional		$39.81	$95.50	$134.90
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $53.70	Facility	26	$7.94	$37.15	$53.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $158.49 / $316.23	Professional		$102.33	$158.49	$316.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $41.69 / $81.28	Professional	26	$28.84	$41.69	$81.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $104.71 / $229.09	Professional	TC	$69.18	$104.71	$229.09
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $407.38 / $407.38	Professional		$407.38	$407.38	$407.38
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $112.20 / $112.20	Professional	26	$112.20	$112.20	$112.20
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $302.00 / $302.00	Professional	TC	$302.00	$302.00	$302.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $134.90 / $173.78	Professional		$102.33	$134.90	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $125.89 / $263.03	Professional		$85.11	$125.89	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $35.48 / $70.79	Professional	26	$24.55	$35.48	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $89.13 / $186.21	Professional	TC	$60.26	$89.13	$186.21