Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $72.44 / $177.83	Facility	26	$54.95	$72.44	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $331.13 / $1,096.48	Professional		$134.90	$331.13	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $75.86 / $234.42	Professional	26	$51.29	$75.86	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $257.04 / $630.96	Professional	TC	$112.20	$257.04	$630.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $141.25 / $208.93	Professional		$83.18	$141.25	$208.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $79.43 / $134.90	Professional	26	$44.67	$79.43	$134.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $79.43 / $123.03	Professional	TC	$75.86	$79.43	$123.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $436.52 / $724.44	Professional		$263.03	$436.52	$724.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $87.10 / $158.49	Professional	26	$61.66	$87.10	$158.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $346.74 / $549.54	Professional	TC	$194.98	$346.74	$549.54
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $389.05 / $707.95	Professional		$269.15	$389.05	$707.95
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $100.00 / $181.97	Professional	26	$72.44	$100.00	$181.97
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $288.40 / $512.86	Professional	TC	$199.53	$288.40	$512.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $63.10 / $89.13	Facility	26	$13.49	$63.10	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $316.23 / $588.84	Professional		$162.18	$316.23	$588.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $70.79 / $141.25	Professional	26	$38.90	$70.79	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $229.09 / $436.52	Professional	TC	$114.82	$229.09	$436.52
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $218.78 / $295.12	Professional		$162.18	$218.78	$295.12
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $61.66 / $83.18	Professional	26	$41.69	$61.66	$83.18
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $158.49 / $213.80	Professional	TC	$120.23	$158.49	$213.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $213.80 / $363.08	Professional		$162.18	$213.80	$363.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $114.82	Professional	26	$54.95	$70.79	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $173.78 / $295.12	Professional	TC	$134.90	$173.78	$295.12
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $501.19 / $501.19 / $501.19	Facility	26	$501.19	$501.19	$501.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $1,949.84 / $1,949.84	Professional		$263.03	$1,949.84	$1,949.84
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 $1,621.81 / $1,621.81 / $1,621.81	Professional	TC	$1,621.81	$1,621.81	$1,621.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $66.07 / $213.80	Professional		$32.36	$66.07	$213.80
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $63.10 / $89.13	Facility	26	$13.49	$63.10	$89.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $331.13 / $524.81	Professional		$165.96	$331.13	$524.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $69.18 / $123.03	Professional	26	$36.31	$69.18	$123.03
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $229.09 / $436.52	Professional	TC	$114.82	$229.09	$436.52
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $660.69 / $660.69	Professional		$660.69	$660.69	$660.69
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	26	$204.17	$204.17	$204.17
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $446.68 / $446.68	Professional	TC	$446.68	$446.68	$446.68
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $245.47 / $616.60	Professional		$177.83	$245.47	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $251.19 / $501.19	Professional		$169.82	$251.19	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $60.26 / $128.82	Professional	26	$44.67	$60.26	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $181.97 / $380.19	Professional	TC	$114.82	$181.97	$380.19