Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.12 / $49.95 / $263.44	Facility	26	$45.12	$49.95	$263.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $137.22 / $161.74 / $682.05	Professional		$137.22	$161.74	$682.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.05 / $49.95 / $189.20	Professional	26	$43.05	$49.95	$189.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.16 / $111.48 / $296.33	Professional	TC	$94.16	$111.48	$296.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.41 / $128.41 / $135.97	Professional		$128.41	$128.41	$135.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.97 / $97.24 / $101.14	Professional	26	$32.97	$97.24	$101.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $172.34 / $296.16 / $532.78	Professional		$172.34	$296.16	$532.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.26 / $90.66 / $165.20	Professional	26	$53.26	$90.66	$165.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.83 / $204.38 / $371.50	Professional	TC	$110.83	$204.38	$371.50
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $115.42 / $189.33 / $460.32	Professional		$115.42	$189.33	$460.32
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.12 / $58.43 / $136.91	Professional	26	$46.12	$58.43	$136.91
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $134.02 / $323.44	Professional	TC	$100.00	$134.02	$323.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.06 / $49.06 / $49.06	Facility	26	$49.06	$49.06	$49.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.02 / $220.05 / $427.10	Professional		$141.02	$220.05	$427.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.25 / $62.73 / $130.26	Professional	26	$47.25	$62.73	$130.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $99.60 / $162.24 / $314.27	Professional	TC	$99.60	$162.24	$314.27
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $150.10 / $180.12 / $235.53	Professional		$150.10	$180.12	$235.53
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.96 / $60.04 / $72.05	Professional	26	$47.96	$60.04	$72.05
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $90.06 / $126.51 / $170.79	Professional	TC	$90.06	$126.51	$170.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $135.15 / $176.22 / $337.76	Professional		$135.15	$176.22	$337.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.39 / $59.75 / $100.53	Professional	26	$42.39	$59.75	$100.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $101.21 / $148.43 / $248.19	Professional	TC	$101.21	$148.43	$248.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $101.58 / $211.00 / $214.35	Facility	26	$101.58	$211.00	$214.35
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,086.26 / $1,086.26 / $1,129.05	Professional		$1,086.26	$1,086.26	$1,129.05
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $449.09 / $449.09 / $449.09	Professional	26	$449.09	$449.09	$449.09
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $867.64 / $893.67 / $893.67	Professional	TC	$867.64	$893.67	$893.67
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $126.02	Professional		$32.34	$32.34	$126.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $49.06 / $49.06 / $49.06	Facility	26	$49.06	$49.06	$49.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $145.22 / $236.04 / $402.75	Professional		$145.22	$236.04	$402.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.33 / $61.18 / $121.96	Professional	26	$47.33	$61.18	$121.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $99.60 / $164.22 / $303.68	Professional	TC	$99.60	$164.22	$303.68
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $472.26 / $472.26 / $472.26	Professional		$472.26	$472.26	$472.26
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $147.59 / $147.59 / $147.59	Professional	26	$147.59	$147.59	$147.59
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $324.67 / $324.67 / $324.67	Professional	TC	$324.67	$324.67	$324.67
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $141.10 / $194.02 / $409.60	Professional		$141.10	$194.02	$409.60
United Facility/Professional Professional Modifier Low / Median / High Price $111.72 / $176.86 / $395.33	Professional		$111.72	$176.86	$395.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.84 / $51.31 / $122.93	Professional	26	$35.84	$51.31	$122.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.17 / $121.96 / $301.83	Professional	TC	$73.17	$121.96	$301.83