Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.23 / $80.00 / $414.83	Facility	26	$72.23	$80.00	$414.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $197.33 / $251.24 / $994.00	Professional		$197.33	$251.24	$994.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.18 / $96.17 / $374.97	Professional	26	$70.18	$96.17	$374.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $127.15 / $148.83 / $369.24	Professional	TC	$127.15	$148.83	$369.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.47 / $172.64 / $401.64	Professional		$162.47	$172.64	$401.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $60.39 / $146.77 / $372.32	Professional	26	$60.39	$146.77	$372.32
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $207.43 / $348.19 / $636.36	Professional		$207.43	$348.19	$636.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.06 / $144.41 / $261.37	Professional	26	$80.06	$144.41	$261.37
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $108.36 / $206.09 / $397.20	Professional	TC	$108.36	$206.09	$397.20
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $132.71 / $208.68 / $521.79	Professional		$132.71	$208.68	$521.79
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.76 / $77.55 / $183.34	Professional	26	$60.76	$77.55	$183.34
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $134.87 / $338.34	Professional	TC	$100.00	$134.87	$338.34
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $184.21 / $278.74 / $596.41	Professional		$184.21	$278.74	$596.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.54 / $99.94 / $210.43	Professional	26	$74.54	$99.94	$210.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.36 / $190.52 / $419.03	Professional	TC	$109.36	$190.52	$419.03
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $96.12 / $233.55 / $315.29	Professional		$96.12	$233.55	$315.29
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.06 / $75.83 / $102.37	Professional	26	$48.06	$75.83	$102.37
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.06 / $157.72 / $212.92	Professional	TC	$48.06	$157.72	$212.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.65 / $237.14 / $446.82	Professional		$181.65	$237.14	$446.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.00 / $94.43 / $158.91	Professional	26	$67.00	$94.43	$158.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $126.18 / $185.02 / $309.35	Professional	TC	$126.18	$185.02	$309.35
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $160.72 / $333.40 / $557.91	Facility	26	$160.72	$333.40	$557.91
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,518.68 / $1,677.02 / $1,677.02	Professional		$1,518.68	$1,677.02	$1,677.02
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $718.23 / $718.23 / $718.23	Professional	26	$718.23	$718.23	$718.23
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $978.30 / $985.97 / $985.97	Professional	TC	$978.30	$985.97	$985.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $158.13	Professional		$32.34	$32.34	$158.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Providence Facility/Professional Professional Modifier Low / Median / High Price $189.21 / $302.35 / $560.60	Professional		$189.21	$302.35	$560.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $74.70 / $97.79 / $192.25	Professional	26	$74.70	$97.79	$192.25
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $105.00 / $187.54 / $404.17	Professional	TC	$105.00	$187.54	$404.17
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $633.13 / $633.13 / $633.13	Professional		$633.13	$633.13	$633.13
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $232.73 / $232.73 / $232.73	Professional	26	$232.73	$232.73	$232.73
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $400.40 / $400.40 / $400.40	Professional	TC	$400.40	$400.40	$400.40
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $179.24 / $227.33 / $262.30	Professional		$179.24	$227.33	$262.30
United Facility/Professional Professional Modifier Low / Median / High Price $150.08 / $223.92 / $530.01	Professional		$150.08	$223.92	$530.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.56 / $81.61 / $190.21	Professional	26	$56.56	$81.61	$190.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.52 / $143.38 / $347.65	Professional	TC	$93.52	$143.38	$347.65