Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.82 / $53.96 / $290.38	Facility	26	$44.82	$53.96	$290.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $148.03 / $206.86 / $887.00	Professional		$148.03	$206.86	$887.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.89 / $52.10 / $193.65	Professional	26	$42.89	$52.10	$193.65
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $343.50 / $392.00 / $662.00	Professional	52	$343.50	$392.00	$662.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.97 / $124.95 / $326.24	Professional	TC	$101.97	$124.95	$326.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $124.20 / $168.68 / $429.24	Professional		$124.20	$168.68	$429.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.97 / $52.45 / $105.80	Professional	26	$34.97	$52.45	$105.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $114.76 / $204.57 / $204.57	Professional	TC	$114.76	$204.57	$204.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $157.90 / $230.11 / $464.72	Professional		$157.90	$230.11	$464.72
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.77 / $62.89 / $126.01	Professional	26	$42.77	$62.89	$126.01
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $111.72 / $166.52 / $338.71	Professional	TC	$111.72	$166.52	$338.71
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $118.27 / $186.07 / $446.55	Professional		$118.27	$186.07	$446.55
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.68 / $47.59 / $116.13	Professional	26	$37.68	$47.59	$116.13
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $135.22 / $322.02	Professional	TC	$100.00	$135.22	$322.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.31 / $217.75 / $477.58	Professional		$145.31	$217.75	$477.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.77 / $60.55 / $131.13	Professional	26	$41.77	$60.55	$131.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $106.57 / $157.56 / $344.25	Professional	TC	$106.57	$157.56	$344.25
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $148.03 / $205.43 / $277.33	Professional		$148.03	$205.43	$277.33
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.97 / $52.29 / $70.59	Professional	26	$39.97	$52.29	$70.59
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $108.06 / $153.13 / $206.73	Professional	TC	$108.06	$153.13	$206.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $155.26 / $204.19 / $332.04	Professional		$155.26	$204.19	$332.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.25 / $62.75 / $98.31	Professional	26	$46.25	$62.75	$98.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $122.50 / $177.14 / $287.22	Professional	TC	$122.50	$177.14	$287.22
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $111.37 / $230.38 / $230.38	Facility	26	$111.37	$230.38	$230.38
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,024.30 / $1,024.30 / $1,326.30	Professional		$1,024.30	$1,024.30	$1,326.30
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $300.10 / $300.10 / $376.28	Professional	26	$300.10	$300.10	$376.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $724.19 / $724.19 / $950.03	Professional	TC	$724.19	$724.19	$950.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $122.61	Professional		$32.34	$32.34	$122.61
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $150.31 / $244.07 / $451.25	Professional		$150.31	$244.07	$451.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.83 / $59.66 / $128.52	Professional	26	$41.83	$59.66	$128.52
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $179.22 / $179.22 / $183.92	Professional	52	$179.22	$179.22	$183.92
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $106.57 / $157.22 / $344.25	Professional	TC	$106.57	$157.22	$344.25
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $563.87 / $563.87 / $563.87	Professional		$563.87	$563.87	$563.87
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $162.91 / $162.91 / $162.91	Professional	26	$162.91	$162.91	$162.91
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $400.96 / $400.96 / $400.96	Professional	TC	$400.96	$400.96	$400.96
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $166.14 / $207.24 / $251.64	Professional		$166.14	$207.24	$251.64
United Facility/Professional Professional Modifier Low / Median / High Price $135.56 / $188.97 / $570.12	Professional		$135.56	$188.97	$570.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.22 / $56.38 / $133.25	Professional	26	$39.22	$56.38	$133.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.34 / $133.57 / $372.76	Professional	TC	$96.34	$133.57	$372.76