Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.36 / $65.18 / $358.96	Facility	26	$59.36	$65.18	$358.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.21 / $191.59 / $547.75	Professional		$119.21	$191.59	$547.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.52 / $66.15 / $185.28	Professional	26	$56.52	$66.15	$185.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.95 / $123.51 / $326.89	Professional	TC	$58.95	$123.51	$326.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $210.19 / $210.19 / $210.19	Professional		$210.19	$210.19	$210.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $299.08 / $299.08 / $299.08	Professional	26	$299.08	$299.08	$299.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.10 / $221.60 / $418.20	Professional		$144.10	$221.60	$418.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.04 / $83.82 / $170.66	Professional	26	$54.04	$83.82	$170.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $91.11 / $140.11 / $259.76	Professional	TC	$91.11	$140.11	$259.76
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $127.64 / $206.65 / $487.76	Professional		$127.64	$206.65	$487.76
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $63.09 / $79.87 / $187.59	Professional	26	$63.09	$79.87	$187.59
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $130.78 / $303.93	Professional	TC	$100.00	$130.78	$303.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.87 / $67.87 / $67.87	Facility	26	$67.87	$67.87	$67.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.52 / $207.03 / $405.69	Professional		$131.52	$207.03	$405.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.10 / $82.28 / $173.22	Professional	26	$62.10	$82.28	$173.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.61 / $121.79 / $236.02	Professional	TC	$65.61	$121.79	$236.02
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $145.69 / $165.62 / $248.43	Professional		$145.69	$165.62	$248.43
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.69 / $66.14 / $89.29	Professional	26	$49.69	$66.14	$89.29
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.55 / $115.93 / $173.90	Professional	TC	$79.55	$115.93	$173.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.52 / $150.13 / $294.54	Professional		$114.52	$150.13	$294.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.34 / $82.32 / $138.53	Professional	26	$58.34	$82.32	$138.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $64.87 / $95.08 / $156.03	Professional	TC	$64.87	$95.08	$156.03
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $139.35 / $290.61 / $352.88	Facility	26	$139.35	$290.61	$352.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,010.47 / $1,060.27 / $1,089.32	Professional		$1,010.47	$1,060.27	$1,089.32
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $369.36 / $369.36 / $471.98	Professional	26	$369.36	$369.36	$471.98
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $681.15 / $707.89 / $727.29	Professional	TC	$681.15	$707.89	$727.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $84.79	Professional		$32.34	$32.34	$84.79
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $67.87 / $67.87 / $67.87	Facility	26	$67.87	$67.87	$67.87
Providence Facility/Professional Professional Modifier Low / Median / High Price $139.94 / $222.89 / $352.43	Professional		$139.94	$222.89	$352.43
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $62.25 / $79.55 / $164.50	Professional	26	$62.25	$79.55	$164.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $68.81 / $124.84 / $217.99	Professional	TC	$68.81	$124.84	$217.99
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $406.33 / $406.33 / $406.33	Professional		$406.33	$406.33	$406.33
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $201.32 / $201.32 / $201.32	Professional	26	$201.32	$201.32	$201.32
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 $117.82 / $165.62 / $451.94	Professional		$117.82	$165.62	$451.94
United Facility/Professional Professional Modifier Low / Median / High Price $99.18 / $161.50 / $371.47	Professional		$99.18	$161.50	$371.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.72 / $66.50 / $162.13	Professional	26	$48.72	$66.50	$162.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.88 / $93.67 / $197.80	Professional	TC	$47.88	$93.67	$197.80