Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.02 / $15.76 / $94.12	Facility	26	$15.02	$15.76	$94.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.76 / $88.49 / $290.00	Professional		$56.76	$88.49	$290.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $20.83 / $74.00	Professional	26	$14.36	$20.83	$74.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $53.82 / $166.27	Professional	TC	$42.39	$53.82	$166.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $58.01 / $101.18 / $378.73	Professional		$58.01	$101.18	$378.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.06 / $24.33 / $30.45	Professional	26	$12.06	$24.33	$30.45
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $101.36 / $101.36 / $101.36	Professional	TC	$101.36	$101.36	$101.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $65.86 / $117.15 / $210.87	Professional		$65.86	$117.15	$210.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.09 / $27.85 / $50.02	Professional	26	$16.09	$27.85	$50.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $52.38 / $89.99 / $160.85	Professional	TC	$52.38	$89.99	$160.85
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $57.81 / $75.93 / $178.75	Professional		$57.81	$75.93	$178.75
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $5.54 / $7.00 / $22.02	Professional	26	$5.54	$7.00	$22.02
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $52.49 / $68.93 / $160.62	Professional	TC	$52.49	$68.93	$160.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.89 / $83.71 / $184.63	Professional		$56.89	$83.71	$184.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.51 / $20.29 / $43.08	Professional	26	$13.51	$20.29	$43.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.54 / $65.01 / $148.86	Professional	TC	$43.54	$65.01	$148.86
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $56.31 / $92.58 / $124.98	Professional		$56.31	$92.58	$124.98
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.08 / $16.71 / $22.56	Professional	26	$14.08	$16.71	$22.56
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.23 / $75.88 / $102.44	Professional	TC	$42.23	$75.88	$102.44
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $205.92 / $205.92 / $205.92	Professional		$205.92	$205.92	$205.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $69.39 / $91.40 / $151.81	Professional		$69.39	$91.40	$151.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.77 / $20.05 / $31.72	Professional	26	$14.77	$20.05	$31.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $60.70 / $87.78 / $142.32	Professional	TC	$60.70	$87.78	$142.32
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $56.31 / $73.77 / $73.77	Facility	26	$56.31	$73.77	$73.77
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $453.03 / $453.03 / $592.79	Professional		$453.03	$453.03	$592.79
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.54 / $95.54 / $122.10	Professional	26	$95.54	$95.54	$122.10
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $357.49 / $357.49 / $470.78	Professional	TC	$357.49	$357.49	$470.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $61.00	Professional		$32.34	$32.34	$61.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.73 / $93.49 / $188.69	Professional		$58.73	$93.49	$188.69
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.52 / $19.72 / $43.04	Professional	26	$13.52	$19.72	$43.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.34 / $64.15 / $146.00	Professional	TC	$44.34	$64.15	$146.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $225.18 / $225.18 / $225.18	Professional		$225.18	$225.18	$225.18
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $52.63 / $52.63 / $52.63	Professional	26	$52.63	$52.63	$52.63
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $172.55 / $172.55 / $172.55	Professional	TC	$172.55	$172.55	$172.55
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $73.20 / $84.24 / $102.96	Professional		$73.20	$84.24	$102.96
United Facility/Professional Professional Modifier Low / Median / High Price $49.73 / $72.00 / $172.51	Professional		$49.73	$72.00	$172.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.07 / $16.96 / $40.35	Professional	26	$13.07	$16.96	$40.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.65 / $54.23 / $150.59	Professional	TC	$36.65	$54.23	$150.59