Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.55 / $56.73 / $425.54	Facility	26	$52.55	$56.73	$425.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $173.18 / $727.00	Professional		$140.29	$173.18	$727.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.40 / $83.65 / $303.86	Professional	26	$51.40	$83.65	$303.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.56 / $110.49 / $297.39	Professional	TC	$71.56	$110.49	$297.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.53 / $115.16 / $278.64	Professional		$77.53	$115.16	$278.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.70 / $108.30 / $337.75	Professional	26	$52.70	$108.30	$337.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $133.77 / $205.67 / $556.45	Professional		$133.77	$205.67	$556.45
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.72 / $76.90 / $291.52	Professional	26	$44.72	$76.90	$291.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.32 / $134.06 / $355.53	Professional	TC	$83.32	$134.06	$355.53
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $148.58 / $425.28	Professional		$100.00	$148.58	$425.28
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.76 / $66.62 / $150.43	Professional	26	$48.76	$66.62	$150.43
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $66.40 / $85.83 / $287.80	Professional	TC	$66.40	$85.83	$287.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.31 / $79.31 / $79.31	Facility	26	$79.31	$79.31	$79.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.55 / $225.89 / $500.87	Professional		$115.55	$225.89	$500.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.25 / $75.98 / $194.83	Professional	26	$50.25	$75.98	$194.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.03 / $136.44 / $387.94	Professional	TC	$62.03	$136.44	$387.94
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $111.05 / $154.61 / $208.72	Professional		$111.05	$154.61	$208.72
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.86 / $75.97 / $102.56	Professional	26	$48.86	$75.97	$102.56
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.19 / $78.63 / $106.15	Professional	TC	$62.19	$78.63	$106.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.44 / $160.33 / $290.67	Professional		$123.44	$160.33	$290.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.37 / $94.96 / $160.01	Professional	26	$68.37	$94.96	$160.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $64.12 / $92.17 / $147.82	Professional	TC	$64.12	$92.17	$147.82
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $632.16 / $632.16 / $646.64	Facility	26	$632.16	$632.16	$646.64
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,406.40 / $1,448.59 / $1,448.59	Professional		$1,406.40	$1,448.59	$1,448.59
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $439.49 / $439.49 / $555.45	Professional	26	$439.49	$439.49	$555.45
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,140.03 / $1,174.23 / $1,174.23	Professional	TC	$1,140.03	$1,174.23	$1,174.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $83.36	Professional		$32.34	$32.34	$83.36
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.31 / $79.31 / $79.31	Facility	26	$79.31	$79.31	$79.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.19 / $260.07 / $464.48	Professional		$128.19	$260.07	$464.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $53.11 / $74.81 / $165.82	Professional	26	$53.11	$74.81	$165.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $62.03 / $142.50 / $387.86	Professional	TC	$62.03	$142.50	$387.86
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $499.03 / $499.03 / $499.03	Professional		$499.03	$499.03	$499.03
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $239.92 / $239.92 / $239.92	Professional	26	$239.92	$239.92	$239.92
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $259.10 / $259.10 / $259.10	Professional	TC	$259.10	$259.10	$259.10
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $111.05 / $166.57 / $171.88	Professional		$111.05	$166.57	$171.88
United Facility/Professional Professional Modifier Low / Median / High Price $128.46 / $184.49 / $520.29	Professional		$128.46	$184.49	$520.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.53 / $68.20 / $206.27	Professional	26	$44.53	$68.20	$206.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.26 / $86.14 / $247.61	Professional	TC	$66.26	$86.14	$247.61