Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.30 / $38.24 / $227.34	Facility	26	$28.30	$38.24	$227.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $179.96 / $237.90 / $929.00	Professional		$179.96	$237.90	$929.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.30 / $39.67 / $128.62	Professional	26	$28.30	$39.67	$128.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $148.29 / $173.31 / $498.02	Professional	TC	$148.29	$173.31	$498.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $139.16 / $190.49 / $334.68	Professional		$139.16	$190.49	$334.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.57 / $34.47 / $83.93	Professional	26	$27.57	$34.47	$83.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.87 / $127.62 / $164.64	Professional	TC	$109.87	$127.62	$164.64
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $205.12 / $275.20 / $550.41	Professional		$205.12	$275.20	$550.41
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.54 / $45.78 / $87.04	Professional	26	$34.54	$45.78	$87.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $161.99 / $230.29 / $463.38	Professional	TC	$161.99	$230.29	$463.38
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $143.78 / $238.95 / $581.54	Professional		$143.78	$238.95	$581.54
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.93 / $36.14 / $100.00	Professional	26	$28.93	$36.14	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $121.28 / $204.31 / $493.03	Professional	TC	$121.28	$204.31	$493.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.27 / $43.27 / $43.27	Facility	26	$43.27	$43.27	$43.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $207.22 / $305.58 / $610.53	Professional		$207.22	$305.58	$610.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.07 / $47.06 / $108.00	Professional	26	$31.07	$47.06	$108.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $174.72 / $261.79 / $517.80	Professional	TC	$174.72	$261.79	$517.80
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $156.63 / $238.39 / $332.86	Professional		$156.63	$238.39	$332.86
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.15 / $45.05 / $58.74	Professional	26	$39.15	$45.05	$58.74
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $117.48 / $178.80 / $277.56	Professional	TC	$117.48	$178.80	$277.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $189.44 / $246.56 / $419.15	Professional		$189.44	$246.56	$419.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.52 / $51.19 / $86.41	Professional	26	$36.52	$51.19	$86.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $163.90 / $241.22 / $403.31	Professional	TC	$163.90	$241.22	$403.31
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $87.82 / $189.47 / $210.00	Facility	26	$87.82	$189.47	$210.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,580.85 / $1,582.03 / $1,625.38	Professional		$1,580.85	$1,582.03	$1,625.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $422.69 / $422.69 / $422.69	Professional	26	$422.69	$422.69	$422.69
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,276.50 / $1,414.75 / $1,453.51	Professional	TC	$1,276.50	$1,414.75	$1,453.51
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $204.65	Professional		$32.34	$32.34	$204.65
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.27 / $43.27 / $43.27	Facility	26	$43.27	$43.27	$43.27
Providence Facility/Professional Professional Modifier Low / Median / High Price $210.76 / $328.14 / $574.55	Professional		$210.76	$328.14	$574.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.07 / $45.98 / $101.28	Professional	26	$31.07	$45.98	$101.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $175.45 / $262.27 / $506.45	Professional	TC	$175.45	$262.27	$506.45
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $669.55 / $669.55 / $669.55	Professional		$669.55	$669.55	$669.55
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $128.49 / $128.49 / $128.49	Professional	26	$128.49	$128.49	$128.49
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $541.04 / $541.04 / $541.04	Professional	TC	$541.04	$541.04	$541.04
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $198.66 / $274.16 / $404.42	Professional		$198.66	$274.16	$404.42
United Facility/Professional Professional Modifier Low / Median / High Price $162.84 / $244.53 / $546.73	Professional		$162.84	$244.53	$546.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.12 / $40.78 / $100.63	Professional	26	$27.12	$40.78	$100.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.22 / $202.96 / $494.61	Professional	TC	$130.22	$202.96	$494.61