Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.01 / $43.68 / $235.95	Facility	26	$36.01	$43.68	$235.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.52 / $161.44 / $699.00	Professional		$112.52	$161.44	$699.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.22 / $42.04 / $144.00	Professional	26	$34.22	$42.04	$144.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $606.28 / $606.28 / $606.28	Professional	52	$606.28	$606.28	$606.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.82 / $100.14 / $399.30	Professional	TC	$82.82	$100.14	$399.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $96.61 / $133.61 / $339.61	Professional		$96.61	$133.61	$339.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.55 / $47.27 / $86.26	Professional	26	$30.55	$47.27	$86.26
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $77.09 / $99.35 / $160.46	Professional	TC	$77.09	$99.35	$160.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $124.32 / $181.25 / $365.82	Professional		$124.32	$181.25	$365.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.36 / $50.52 / $100.98	Professional	26	$34.36	$50.52	$100.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.34 / $130.11 / $264.83	Professional	TC	$87.34	$130.11	$264.83
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $146.79 / $353.89	Professional		$100.00	$146.79	$353.89
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.67 / $38.20 / $100.00	Professional	26	$31.67	$38.20	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $82.30 / $106.01 / $252.46	Professional	TC	$82.30	$106.01	$252.46
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.97 / $43.97 / $43.97	Facility	26	$43.97	$43.97	$43.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.85 / $171.72 / $378.08	Professional		$114.85	$171.72	$378.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.77 / $48.79 / $105.39	Professional	26	$33.77	$48.79	$105.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.17 / $123.38 / $269.13	Professional	TC	$83.17	$123.38	$269.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $117.08 / $162.47 / $219.35	Professional		$117.08	$162.47	$219.35
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.78 / $42.39 / $57.23	Professional	26	$32.78	$42.39	$57.23
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $84.30 / $120.09 / $162.12	Professional	TC	$84.30	$120.09	$162.12
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $420.57 / $420.57 / $420.57	Professional		$420.57	$420.57	$420.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $122.96 / $161.74 / $263.00	Professional		$122.96	$161.74	$263.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.54 / $50.87 / $79.69	Professional	26	$37.54	$50.87	$79.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $96.07 / $138.96 / $225.31	Professional	TC	$96.07	$138.96	$225.31
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $90.38 / $187.10 / $187.10	Facility	26	$90.38	$187.10	$187.10
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $810.58 / $810.58 / $1,053.68	Professional		$810.58	$810.58	$1,053.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $242.65 / $242.65 / $307.35	Professional	26	$242.65	$242.65	$307.35
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $567.92 / $567.92 / $746.33	Professional	TC	$567.92	$567.92	$746.33
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 $43.97 / $43.97 / $43.97	Facility	26	$43.97	$43.97	$43.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $118.89 / $191.71 / $360.52	Professional		$118.89	$191.71	$360.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.86 / $48.26 / $103.47	Professional	26	$33.86	$48.26	$103.47
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $141.57 / $141.57 / $145.59	Professional	52	$141.57	$141.57	$145.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $83.17 / $122.94 / $269.13	Professional	TC	$83.17	$122.94	$269.13
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $447.01 / $447.01 / $447.01	Professional		$447.01	$447.01	$447.01
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $132.60 / $132.60 / $132.60	Professional	26	$132.60	$132.60	$132.60
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $314.39 / $314.39 / $314.39	Professional	TC	$314.39	$314.39	$314.39
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $131.40 / $163.92 / $199.04	Professional		$131.40	$163.92	$199.04
United Facility/Professional Professional Modifier Low / Median / High Price $106.86 / $150.06 / $345.97	Professional		$106.86	$150.06	$345.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.55 / $46.05 / $102.99	Professional	26	$31.55	$46.05	$102.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.31 / $104.37 / $244.35	Professional	TC	$75.31	$104.37	$244.35