Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.28 / $49.96 / $96.04	Facility	26	$48.28	$49.96	$96.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $135.55 / $158.85 / $512.00	Professional		$135.55	$158.85	$512.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.10 / $57.92 / $184.07	Professional	26	$46.10	$57.92	$184.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.30 / $103.98 / $267.25	Professional	TC	$88.30	$103.98	$267.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $115.01 / $139.83 / $197.53	Professional		$115.01	$139.83	$197.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.69 / $52.56 / $114.50	Professional	26	$37.69	$52.56	$114.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $116.09 / $185.10 / $185.10	Professional	TC	$116.09	$185.10	$185.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $145.13 / $183.58 / $374.94	Professional		$145.13	$183.58	$374.94
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.81 / $61.81 / $126.30	Professional	26	$51.81	$61.81	$126.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.22 / $122.48 / $250.15	Professional	TC	$95.22	$122.48	$250.15
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $104.26 / $161.53 / $369.65	Professional		$104.26	$161.53	$369.65
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.36 / $52.38 / $119.87	Professional	26	$38.36	$52.38	$119.87
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $86.33 / $109.15 / $248.65	Professional	TC	$86.33	$109.15	$248.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.83 / $186.95 / $382.82	Professional		$96.83	$186.95	$382.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.74 / $61.50 / $130.80	Professional	26	$29.74	$61.50	$130.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.77 / $118.60 / $260.69	Professional	TC	$64.77	$118.60	$260.69
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $131.79 / $178.55 / $241.04	Professional		$131.79	$178.55	$241.04
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.81 / $56.63 / $76.45	Professional	26	$44.81	$56.63	$76.45
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.98 / $121.92 / $164.59	Professional	TC	$86.98	$121.92	$164.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $135.94 / $178.55 / $290.54	Professional		$135.94	$178.55	$290.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $67.95 / $107.55	Professional	26	$50.12	$67.95	$107.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $94.05 / $141.08 / $228.74	Professional	TC	$94.05	$141.08	$228.74
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $466.96 / $466.96 / $479.84	Facility	26	$466.96	$466.96	$479.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $915.52 / $915.52 / $1,167.08	Professional		$915.52	$915.52	$1,167.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $323.73 / $323.73 / $409.43	Professional	26	$323.73	$323.73	$409.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $591.79 / $591.79 / $757.65	Professional	TC	$591.79	$591.79	$757.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $83.84	Professional		$32.34	$32.34	$83.84
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $103.71 / $211.94 / $403.75	Professional		$103.71	$211.94	$403.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.01 / $58.85 / $129.81	Professional	26	$28.01	$58.85	$129.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $54.13 / $116.14 / $267.66	Professional	TC	$54.13	$116.14	$267.66
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $144.38 / $184.51 / $224.04	Professional		$144.38	$184.51	$224.04
United Facility/Professional Professional Modifier Low / Median / High Price $124.48 / $161.93 / $401.59	Professional		$124.48	$161.93	$401.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.91 / $56.63 / $132.44	Professional	26	$42.91	$56.63	$132.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.56 / $105.82 / $267.73	Professional	TC	$81.56	$105.82	$267.73