Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $24.55 / $117.49	Facility	26	$18.20	$24.55	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $109.65 / $269.15	Professional		$74.13	$109.65	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $26.92 / $66.07	Professional	26	$17.38	$26.92	$66.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $77.62 / $199.53	Professional	TC	$54.95	$77.62	$199.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $141.25	Professional		$87.10	$87.10	$141.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $18.62 / $18.62	Professional	26	$18.62	$18.62	$18.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $169.82 / $288.40	Professional		$109.65	$169.82	$288.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $38.90 / $64.57	Professional	26	$26.30	$38.90	$64.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $131.83 / $229.09	Professional	TC	$91.20	$131.83	$229.09
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $123.03 / $245.47	Professional		$87.10	$123.03	$245.47
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.23 / $26.92	Professional	26	$7.08	$10.23	$26.92
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $112.20 / $218.78	Professional	TC	$79.43	$112.20	$218.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.90 / $22.91 / $32.36	Facility	26	$4.90	$22.91	$32.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $112.20 / $218.78	Professional		$77.62	$112.20	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $25.70 / $50.12	Professional	26	$17.38	$25.70	$50.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $85.11 / $181.97	Professional	TC	$58.88	$85.11	$181.97
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $134.90 / $181.97	Professional		$72.44	$134.90	$181.97
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $22.91 / $30.90	Professional	26	$17.38	$22.91	$30.90
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $109.65 / $147.91	Professional	TC	$54.95	$109.65	$147.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $125.89 / $208.93	Professional		$97.72	$125.89	$208.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $26.30 / $42.66	Professional	26	$19.95	$26.30	$42.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $117.49 / $208.93	Professional	TC	$91.20	$117.49	$208.93
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	26	$128.82	$128.82	$128.82
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $831.76 / $831.76	Professional		$630.96	$831.76	$831.76
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $162.18 / $162.18	Professional	26	$128.82	$162.18	$162.18
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $660.69 / $660.69	Professional	TC	$512.86	$660.69	$660.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $33.11 / $112.20	Professional		$23.99	$33.11	$112.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $4.90 / $22.91 / $32.36	Facility	26	$4.90	$22.91	$32.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $117.49 / $245.47	Professional		$77.62	$117.49	$245.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $24.55 / $46.77	Professional	26	$16.98	$24.55	$46.77
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $81.28 / $165.96	Professional	TC	$57.54	$81.28	$165.96
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $102.33 / $309.03	Professional		$102.33	$102.33	$309.03
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $67.61 / $67.61	Professional	26	$67.61	$67.61	$67.61
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $245.47 / $245.47	Professional	TC	$245.47	$245.47	$245.47
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $109.65 / $131.83	Professional		$72.44	$109.65	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $95.50 / $199.53	Professional		$64.57	$95.50	$199.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $21.38 / $42.66	Professional	26	$16.22	$21.38	$42.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $72.44 / $162.18	Professional	TC	$47.86	$72.44	$162.18