Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $66.07 / $239.88	Facility	26	$44.67	$66.07	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $165.96 / $676.08	Professional		$128.82	$165.96	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $54.95 / $190.55	Professional	26	$40.74	$54.95	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $117.49 / $281.84	Professional	TC	$87.10	$117.49	$281.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $141.25	Professional		$100.00	$100.00	$141.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $46.77 / $100.00	Professional	26	$33.11	$46.77	$100.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $309.03 / $478.63	Professional		$204.17	$309.03	$478.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $93.33 / $141.25	Professional	26	$63.10	$93.33	$141.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $218.78 / $346.74	Professional	TC	$141.25	$218.78	$346.74
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $239.88 / $457.09	Professional		$165.96	$239.88	$457.09
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $72.44 / $138.04	Professional	26	$51.29	$72.44	$138.04
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $169.82 / $331.13	Professional	TC	$114.82	$169.82	$331.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $70.79	Facility	26	$10.47	$48.98	$70.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $208.93 / $380.19	Professional		$141.25	$208.93	$380.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $117.49	Professional	26	$46.77	$61.66	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $154.88 / $281.84	Professional	TC	$100.00	$154.88	$281.84
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $181.97 / $245.47	Professional		$151.36	$181.97	$245.47
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $60.26 / $72.44	Professional	26	$50.12	$60.26	$72.44
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $131.83 / $177.83	Professional	TC	$89.13	$131.83	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $169.82 / $323.59	Professional		$134.90	$169.82	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $60.26 / $104.71	Professional	26	$44.67	$60.26	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $147.91 / $251.19	Professional	TC	$104.71	$147.91	$251.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $275.42 / $275.42 / $275.42	Facility	26	$275.42	$275.42	$275.42
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,122.02 / $1,122.02	Professional		$1,096.48	$1,122.02	$1,122.02
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Professional	26	$446.68	$446.68	$446.68
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $891.25 / $891.25 / $891.25	Professional	TC	$891.25	$891.25	$891.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $125.89 / $186.21	Professional		$61.66	$125.89	$186.21
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $70.79	Facility	26	$10.47	$48.98	$70.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $223.87 / $363.08	Professional		$141.25	$223.87	$363.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $60.26 / $112.20	Professional	26	$46.77	$60.26	$112.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $154.88 / $269.15	Professional	TC	$100.00	$154.88	$269.15
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $467.74 / $467.74	Professional		$467.74	$467.74	$467.74
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $147.91 / $147.91	Professional	26	$147.91	$147.91	$147.91
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $323.59 / $323.59	Professional	TC	$323.59	$323.59	$323.59
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $302.00 / $467.74	Professional		$151.36	$302.00	$467.74
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $173.78 / $331.13	Professional		$112.20	$173.78	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $51.29 / $97.72	Professional	26	$37.15	$51.29	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $123.03 / $245.47	Professional	TC	$72.44	$123.03	$245.47