Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $50.12 / $173.78	Facility	26	$25.12	$50.12	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $128.82 / $489.78	Professional		$89.13	$128.82	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $33.88 / $147.91	Professional	26	$22.91	$33.88	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $97.72 / $239.88	Professional	TC	$66.07	$97.72	$239.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $58.88 / $58.88	Professional	26	$58.88	$58.88	$58.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $138.04 / $363.08	Professional		$95.50	$138.04	$363.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $45.71 / $109.65	Professional	26	$28.18	$45.71	$109.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $102.33 / $281.84	Professional	TC	$67.61	$102.33	$281.84
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $138.04 / $288.40	Professional		$91.20	$138.04	$288.40
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $38.02 / $75.86	Professional	26	$26.92	$38.02	$75.86
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $97.72 / $208.93	Professional	TC	$64.57	$97.72	$208.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	26	$6.76	$31.62	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $141.25 / $281.84	Professional		$97.72	$141.25	$281.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $35.48 / $70.79	Professional	26	$23.99	$35.48	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $107.15 / $229.09	Professional	TC	$69.18	$107.15	$229.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $181.97 / $245.47	Professional		$75.86	$181.97	$245.47
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $33.11 / $44.67	Professional	26	$20.42	$33.11	$44.67
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $147.91 / $199.53	Professional	TC	$54.95	$147.91	$199.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $288.40	Professional		$131.83	$169.82	$288.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $38.02 / $61.66	Professional	26	$28.84	$38.02	$61.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $158.49 / $275.42	Professional	TC	$123.03	$158.49	$275.42
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $177.83 / $177.83	Facility	26	$177.83	$177.83	$177.83
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,047.13 / $1,047.13	Professional		$870.96	$1,047.13	$1,047.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $223.87 / $223.87	Professional	26	$199.53	$223.87	$223.87
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $831.76 / $831.76	Professional	TC	$691.83	$831.76	$831.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $147.91	Professional		$32.36	$33.11	$147.91
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	26	$6.76	$31.62	$44.67
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $151.36 / $309.03	Professional		$97.72	$151.36	$309.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $33.11 / $66.07	Professional	26	$23.99	$33.11	$66.07
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $102.33 / $213.80	Professional	TC	$69.18	$102.33	$213.80
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $407.38 / $407.38	Professional		$407.38	$407.38	$407.38
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	26	$95.50	$95.50	$95.50
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $316.23 / $316.23	Professional	TC	$316.23	$316.23	$316.23
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $151.36 / $194.98	Professional		$112.20	$151.36	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $125.89 / $263.03	Professional		$75.86	$125.89	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $30.20 / $60.26	Professional	26	$21.38	$30.20	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $95.50 / $204.17	Professional	TC	$56.23	$95.50	$204.17