Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.30 / $17.05 / $106.87	Facility	26	$16.30	$17.05	$106.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.64 / $82.68 / $251.58	Professional		$61.64	$82.68	$251.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.91 / $17.05 / $45.31	Professional	26	$14.91	$17.05	$45.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.51 / $53.15 / $118.29	Professional	TC	$45.51	$53.15	$118.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $54.19 / $54.19 / $59.33	Professional		$54.19	$54.19	$59.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.68 / $12.68 / $12.86	Professional	26	$12.68	$12.68	$12.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.27 / $128.19 / $243.46	Professional		$75.27	$128.19	$243.46
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.69 / $30.44 / $56.70	Professional	26	$17.69	$30.44	$56.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.42 / $97.75 / $185.65	Professional	TC	$58.42	$97.75	$185.65
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $62.73 / $82.41 / $194.14	Professional		$62.73	$82.41	$194.14
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $5.59 / $7.05 / $22.16	Professional	26	$5.59	$7.05	$22.16
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $57.37 / $75.36 / $175.68	Professional	TC	$57.37	$75.36	$175.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.60 / $19.60 / $19.60	Facility	26	$19.60	$19.60	$19.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.22 / $94.60 / $213.59	Professional		$64.22	$94.60	$213.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.24 / $22.15 / $47.68	Professional	26	$15.24	$22.15	$47.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.75 / $71.65 / $167.68	Professional	TC	$47.75	$71.65	$167.68
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $61.12 / $105.47 / $142.38	Professional		$61.12	$105.47	$142.38
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.28 / $19.35 / $26.12	Professional	26	$15.28	$19.35	$26.12
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.84 / $86.12 / $116.26	Professional	TC	$45.84	$86.12	$116.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $76.91 / $104.05 / $166.88	Professional		$76.91	$104.05	$166.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.96 / $23.22 / $36.75	Professional	26	$16.96	$23.22	$36.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $68.90 / $99.72 / $161.66	Professional	TC	$68.90	$99.72	$161.66
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $64.34 / $84.60 / $84.60	Facility	26	$64.34	$84.60	$84.60
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $507.76 / $507.76 / $673.88	Professional		$507.76	$507.76	$673.88
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.02 / $109.02 / $136.88	Professional	26	$109.02	$109.02	$136.88
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $398.67 / $398.67 / $537.00	Professional	TC	$398.67	$398.67	$537.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $68.33	Professional		$32.34	$32.34	$68.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $19.60 / $19.60 / $19.60	Facility	26	$19.60	$19.60	$19.60
Providence Facility/Professional Professional Modifier Low / Median / High Price $68.31 / $106.00 / $214.70	Professional		$68.31	$106.00	$214.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.32 / $21.78 / $46.79	Professional	26	$15.32	$21.78	$46.79
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $50.09 / $70.56 / $163.27	Professional	TC	$50.09	$70.56	$163.27
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $262.25 / $262.25 / $262.25	Professional		$262.25	$262.25	$262.25
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $59.64 / $59.64 / $59.64	Professional	26	$59.64	$59.64	$59.64
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $202.60 / $202.60 / $202.60	Professional	TC	$202.60	$202.60	$202.60
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $79.45 / $95.96 / $117.28	Professional		$79.45	$95.96	$117.28
United Facility/Professional Professional Modifier Low / Median / High Price $54.00 / $79.76 / $220.26	Professional		$54.00	$79.76	$220.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.21 / $18.95 / $44.40	Professional	26	$14.21	$18.95	$44.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.79 / $60.99 / $154.09	Professional	TC	$39.79	$60.99	$154.09