Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $67.61 / $302.00	Facility	26	$47.86	$67.61	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $199.53 / $575.44	Professional		$134.90	$199.53	$575.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $75.86 / $194.98	Professional	26	$47.86	$75.86	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $112.20 / $338.84	Professional	TC	$89.13	$112.20	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $141.25 / $263.03	Professional		$112.20	$141.25	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $83.18 / $117.49	Professional	26	$40.74	$83.18	$117.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $104.71 / $190.55	Professional	TC	$79.43	$104.71	$190.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $213.80 / $416.87	Professional		$154.88	$213.80	$416.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $70.79 / $144.54	Professional	26	$52.48	$70.79	$144.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $141.25 / $281.84	Professional	TC	$104.71	$141.25	$281.84
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $213.80 / $407.38	Professional		$147.91	$213.80	$407.38
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $131.83	Professional	26	$50.12	$70.79	$131.83
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $141.25 / $275.42	Professional	TC	$100.00	$141.25	$275.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $57.54 / $83.18	Facility	26	$12.59	$57.54	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $190.55 / $346.74	Professional		$104.71	$190.55	$346.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $63.10 / $123.03	Professional	26	$35.48	$63.10	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $120.23 / $245.47	Professional	TC	$67.61	$120.23	$245.47
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $177.83 / $239.88	Professional		$131.83	$177.83	$239.88
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $56.23 / $75.86	Professional	26	$44.67	$56.23	$75.86
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $123.03 / $165.96	Professional	TC	$87.10	$123.03	$165.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $288.40	Professional		$131.83	$169.82	$288.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $66.07 / $104.71	Professional	26	$50.12	$66.07	$104.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $131.83 / $229.09	Professional	TC	$102.33	$131.83	$229.09
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $467.74 / $467.74 / $467.74	Facility	26	$467.74	$467.74	$467.74
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,174.90 / $1,174.90	Professional		$912.01	$1,174.90	$1,174.90
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $323.59 / $407.38 / $407.38	Professional	26	$323.59	$407.38	$407.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $758.58 / $758.58	Professional	TC	$588.84	$758.58	$758.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $51.29 / $134.90	Professional		$32.36	$51.29	$134.90
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $57.54 / $83.18	Facility	26	$12.59	$57.54	$83.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $199.53 / $371.54	Professional		$102.33	$199.53	$371.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $57.54 / $109.65	Professional	26	$30.90	$57.54	$109.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $109.65 / $229.09	Professional	TC	$64.57	$109.65	$229.09
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $223.87	Professional		$131.83	$169.82	$223.87
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $151.36 / $331.13	Professional		$120.23	$151.36	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $51.29 / $109.65	Professional	26	$41.69	$51.29	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $97.72 / $223.87	Professional	TC	$79.43	$97.72	$223.87