Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.92 / $19.84 / $121.06	Facility	26	$18.92	$19.84	$121.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.73 / $94.70 / $224.35	Professional		$73.73	$94.70	$224.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.00 / $20.68 / $64.00	Professional	26	$18.00	$20.68	$64.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.57 / $66.42 / $161.44	Professional	TC	$55.57	$66.42	$161.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.09 / $140.19 / $213.96	Professional		$81.09	$140.19	$213.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.39 / $31.39 / $31.39	Professional	26	$31.39	$31.39	$31.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.36 / $152.77 / $290.13	Professional		$92.36	$152.77	$290.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.55 / $35.39 / $64.44	Professional	26	$20.55	$35.39	$64.44
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.56 / $117.63 / $222.92	Professional	TC	$72.56	$117.63	$222.92
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $76.34 / $98.24 / $231.43	Professional		$76.34	$98.24	$231.43
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $6.37 / $8.05 / $23.73	Professional	26	$6.37	$8.05	$23.73
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $68.66 / $90.19 / $210.05	Professional	TC	$68.66	$90.19	$210.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.94 / $112.19 / $245.59	Professional		$74.94	$112.19	$245.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.39 / $25.74 / $55.34	Professional	26	$17.39	$25.74	$55.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $59.98 / $86.41 / $212.60	Professional	TC	$59.98	$86.41	$212.60
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $73.11 / $129.75 / $175.16	Professional		$73.11	$129.75	$175.16
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.55 / $22.52 / $30.40	Professional	26	$17.55	$22.52	$30.40
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.56 / $107.23 / $144.76	Professional	TC	$55.56	$107.23	$144.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $94.58 / $127.96 / $210.20	Professional		$94.58	$127.96	$210.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.82 / $27.02 / $42.77	Professional	26	$19.82	$27.02	$42.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $85.78 / $124.11 / $201.23	Professional	TC	$85.78	$124.11	$201.23
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $75.25 / $98.94 / $98.94	Facility	26	$75.25	$98.94	$98.94
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $637.19 / $637.19 / $829.20	Professional		$637.19	$637.19	$829.20
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $127.82 / $127.82 / $162.08	Professional	26	$127.82	$127.82	$162.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $509.36 / $509.36 / $667.13	Professional	TC	$509.36	$509.36	$667.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $72.93	Professional		$32.34	$32.34	$72.93
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $80.89 / $126.51 / $265.06	Professional		$80.89	$126.51	$265.06
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.64 / $25.46 / $54.40	Professional	26	$17.64	$25.46	$54.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $61.45 / $85.20 / $194.23	Professional	TC	$61.45	$85.20	$194.23
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $311.24 / $311.24 / $311.24	Professional		$311.24	$311.24	$311.24
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $67.75 / $67.75 / $67.75	Professional	26	$67.75	$67.75	$67.75
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $243.48 / $243.48 / $243.48	Professional	TC	$243.48	$243.48	$243.48
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $95.05 / $118.05 / $144.29	Professional		$95.05	$118.05	$144.29
United Facility/Professional Professional Modifier Low / Median / High Price $64.52 / $98.53 / $269.73	Professional		$64.52	$98.53	$269.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $22.59 / $60.92	Professional	26	$16.48	$22.59	$60.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.03 / $73.26 / $189.25	Professional	TC	$48.03	$73.26	$189.25