Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.19 / $48.11 / $260.70	Facility	26	$43.19	$48.11	$260.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.15 / $160.30 / $285.64	Professional		$127.15	$160.30	$285.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.89 / $48.10 / $186.78	Professional	26	$40.89	$48.10	$186.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $604.69 / $604.69 / $604.69	Professional	50	$604.69	$604.69	$604.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $80.73 / $96.90 / $218.29	Professional	TC	$80.73	$96.90	$218.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $192.32 / $192.32 / $192.32	Professional	26	$192.32	$192.32	$192.32
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.68 / $132.57 / $275.29	Professional		$106.68	$132.57	$275.29
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.86 / $51.29 / $103.25	Professional	26	$38.86	$51.29	$103.25
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $144.02 / $168.67 / $272.14	Professional	50	$144.02	$168.67	$272.14
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.97 / $81.59 / $164.67	Professional	TC	$57.97	$81.59	$164.67
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $134.31 / $327.61	Professional		$100.00	$134.31	$327.61
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.01 / $43.84 / $103.27	Professional	26	$33.01	$43.84	$103.27
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $72.70 / $95.09 / $220.27	Professional	TC	$72.70	$95.09	$220.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.14 / $47.14 / $47.14	Facility	26	$47.14	$47.14	$47.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.12 / $162.22 / $333.94	Professional		$117.12	$162.22	$333.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.90 / $55.62 / $117.35	Professional	26	$41.90	$55.62	$117.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.15 / $105.99 / $208.05	Professional	TC	$69.15	$105.99	$208.05
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $81.73 / $155.49 / $280.79	Professional		$81.73	$155.49	$280.79
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.77 / $49.03 / $66.19	Professional	26	$45.77	$49.03	$66.19
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.96 / $68.42 / $214.60	Professional	TC	$35.96	$68.42	$214.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $155.84 / $205.02 / $322.38	Professional		$155.84	$205.02	$322.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.10 / $58.84 / $92.18	Professional	26	$42.10	$58.84	$92.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $127.17 / $183.77 / $297.99	Professional	TC	$127.17	$183.77	$297.99
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $101.49 / $214.20 / $214.20	Facility	26	$101.49	$214.20	$214.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $802.94 / $834.21 / $1,319.18	Professional		$802.94	$834.21	$1,319.18
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $261.89 / $261.89 / $336.38	Professional	26	$261.89	$261.89	$336.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $595.82 / $595.82 / $982.73	Professional	TC	$595.82	$595.82	$982.73
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $162.02	Professional		$32.34	$32.34	$162.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $47.14 / $47.14 / $47.14	Facility	26	$47.14	$47.14	$47.14
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $185.21 / $348.24	Professional		$123.03	$185.21	$348.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.38 / $55.06 / $112.93	Professional	26	$42.38	$55.06	$112.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $70.76 / $105.98 / $198.78	Professional	TC	$70.76	$105.98	$198.78
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $347.35 / $347.35 / $347.35	Professional		$347.35	$347.35	$347.35
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $142.34 / $142.34 / $142.34	Professional	26	$142.34	$142.34	$142.34
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $205.01 / $205.01 / $205.01	Professional	TC	$205.01	$205.01	$205.01
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $103.66 / $174.32 / $231.34	Professional		$103.66	$174.32	$231.34
United Facility/Professional Professional Modifier Low / Median / High Price $87.90 / $128.37 / $271.07	Professional		$87.90	$128.37	$271.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.02 / $48.12 / $110.91	Professional	26	$34.02	$48.12	$110.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $51.04 / $77.89 / $177.78	Professional	TC	$51.04	$77.89	$177.78