Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $304.18 / $304.18 / $304.18	Facility	TC	$304.18	$304.18	$304.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.03 / $106.01 / $372.00	Professional		$64.03	$106.01	$372.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.81 / $52.95 / $286.00	Professional	26	$30.81	$52.95	$286.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.09 / $67.75 / $284.00	Professional	TC	$44.09	$67.75	$284.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $54.45 / $63.20 / $276.25	Professional		$54.45	$63.20	$276.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.30 / $42.69 / $153.00	Professional	26	$16.30	$42.69	$153.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $38.35 / $152.76 / $358.00	Professional	TC	$38.35	$152.76	$358.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.53 / $117.93 / $264.82	Professional		$58.53	$117.93	$264.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.14 / $53.20 / $102.62	Professional	26	$38.14	$53.20	$102.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.39 / $68.56 / $190.50	Professional	TC	$16.39	$68.56	$190.50
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $77.53 / $103.72 / $252.84	Professional		$77.53	$103.72	$252.84
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.81 / $53.56 / $129.83	Professional	26	$37.81	$53.56	$129.83
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $39.38 / $50.16 / $122.28	Professional	TC	$39.38	$50.16	$122.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $181.97 / $181.97	Facility		$181.97	$181.97	$181.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.78 / $68.12 / $208.45	Professional		$48.78	$68.12	$208.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.05 / $22.77 / $82.31	Professional	26	$18.05	$22.77	$82.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.16 / $44.53 / $143.99	Professional	TC	$29.16	$44.53	$143.99
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $53.79 / $146.56 / $197.86	Professional		$53.79	$146.56	$197.86
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.54 / $43.03 / $52.04	Professional	26	$38.54	$43.03	$52.04
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.76 / $108.01 / $145.81	Professional	TC	$10.76	$108.01	$145.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $113.75 / $136.55 / $221.18	Professional		$113.75	$136.55	$221.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.84 / $46.26 / $57.84	Professional	26	$30.84	$46.26	$57.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.78 / $129.05 / $162.02	Professional	TC	$79.78	$129.05	$162.02
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $248.50 / $510.17 / $600.35	Facility		$248.50	$510.17	$600.35
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $80.37 / $170.73 / $170.73	Facility	26	$80.37	$170.73	$170.73
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $170.69 / $357.27 / $432.16	Facility	TC	$170.69	$357.27	$432.16
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $661.34 / $661.34 / $938.48	Professional		$661.34	$661.34	$938.48
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $269.70 / $278.39 / $278.39	Professional	26	$269.70	$278.39	$278.39
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $424.71 / $424.71 / $668.78	Professional	TC	$424.71	$424.71	$668.78
Providence Facility/Professional Facility Modifier Low / Median / High Price $81.94 / $135.00 / $192.63	Facility		$81.94	$135.00	$192.63
Providence Facility/Professional Professional Modifier Low / Median / High Price $50.99 / $118.82 / $284.61	Professional		$50.99	$118.82	$284.61
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.07 / $25.58 / $101.35	Professional	26	$19.07	$25.58	$101.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.16 / $46.92 / $157.79	Professional	TC	$29.16	$46.92	$157.79
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $400.31 / $400.31 / $400.31	Professional		$400.31	$400.31	$400.31
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $134.66 / $134.66 / $134.66	Professional	26	$134.66	$134.66	$134.66
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $265.64 / $265.64 / $265.64	Professional	TC	$265.64	$265.64	$265.64
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $118.54 / $118.54 / $163.00	Professional		$118.54	$118.54	$163.00
United Facility/Professional Professional Modifier Low / Median / High Price $57.31 / $65.40 / $324.12	Professional		$57.31	$65.40	$324.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.09 / $25.22 / $92.22	Professional	26	$22.09	$25.22	$92.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.95 / $45.68 / $202.77	Professional	TC	$34.95	$45.68	$202.77