Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.12 / $24.76 / $173.70	Facility	26	$21.12	$24.76	$173.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.68 / $99.36 / $447.89	Professional		$81.68	$99.36	$447.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $29.62 / $108.00	Professional	26	$19.89	$29.62	$108.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.89 / $69.97 / $175.51	Professional	TC	$58.89	$69.97	$175.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $96.87 / $126.04 / $173.32	Professional		$96.87	$126.04	$173.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.05 / $44.35 / $106.93	Professional	26	$21.05	$44.35	$106.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $78.95 / $107.86 / $213.59	Professional		$78.95	$107.86	$213.59
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.77 / $31.16 / $62.42	Professional	26	$24.77	$31.16	$62.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $52.86 / $76.47 / $155.47	Professional	TC	$52.86	$76.47	$155.47
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $86.23 / $107.34 / $239.70	Professional		$86.23	$107.34	$239.70
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.24 / $26.91 / $66.08	Professional	26	$21.24	$26.91	$66.08
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $65.81 / $83.54 / $179.09	Professional	TC	$65.81	$83.54	$179.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.47 / $115.05 / $267.45	Professional		$76.47	$115.05	$267.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.12 / $30.68 / $71.66	Professional	26	$21.12	$30.68	$71.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.87 / $84.37 / $197.67	Professional	TC	$54.87	$84.37	$197.67
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $38.09 / $124.51 / $168.09	Professional		$38.09	$124.51	$168.09
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.52 / $31.65 / $42.73	Professional	26	$9.52	$31.65	$42.73
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.57 / $92.86 / $125.36	Professional	TC	$28.57	$92.86	$125.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.49 / $123.04 / $210.00	Professional		$91.49	$123.04	$210.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.00 / $37.97 / $59.50	Professional	26	$28.00	$37.97	$59.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.29 / $107.40 / $174.13	Professional	TC	$74.29	$107.40	$174.13
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $139.60 / $139.60	Facility	26	$100.00	$139.60	$139.60
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $648.50 / $648.50 / $804.75	Professional		$648.50	$648.50	$804.75
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $180.32 / $180.32 / $229.28	Professional	26	$180.32	$180.32	$229.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $468.12 / $468.12 / $575.40	Professional	TC	$468.12	$468.12	$575.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $65.20	Professional		$32.34	$32.34	$65.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $80.56 / $130.91 / $270.45	Professional		$80.56	$130.91	$270.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.18 / $30.30 / $66.54	Professional	26	$22.18	$30.30	$66.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $54.76 / $81.39 / $192.14	Professional	TC	$54.76	$81.39	$192.14
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $320.55 / $320.55 / $320.55	Professional		$320.55	$320.55	$320.55
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $97.50 / $97.50 / $97.50	Professional	26	$97.50	$97.50	$97.50
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $223.04 / $223.04 / $223.04	Professional	TC	$223.04	$223.04	$223.04
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $57.13 / $100.70 / $138.46	Professional		$57.13	$100.70	$138.46
United Facility/Professional Professional Modifier Low / Median / High Price $64.98 / $100.79 / $249.97	Professional		$64.98	$100.79	$249.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.98 / $30.68 / $79.75	Professional	26	$17.98	$30.68	$79.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.90 / $70.12 / $227.15	Professional	TC	$44.90	$70.12	$227.15