Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.82 / $33.53 / $203.13	Facility	26	$31.82	$33.53	$203.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.82 / $115.03 / $437.00	Professional		$98.82	$115.03	$437.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.30 / $34.74 / $121.54	Professional	26	$30.30	$34.74	$121.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.12 / $74.94 / $161.22	Professional	TC	$68.12	$74.94	$161.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.22 / $141.66 / $236.33	Professional		$89.22	$141.66	$236.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.77 / $27.34 / $74.19	Professional	26	$19.77	$27.34	$74.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.94 / $138.74 / $289.35	Professional		$105.94	$138.74	$289.35
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.06 / $42.84 / $87.81	Professional	26	$33.06	$42.84	$87.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $73.02 / $96.67 / $201.54	Professional	TC	$73.02	$96.67	$201.54
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $99.90 / $125.96 / $311.20	Professional		$99.90	$125.96	$311.20
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.62 / $40.11 / $100.00	Professional	26	$30.62	$40.11	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $71.34 / $93.67 / $213.94	Professional	TC	$71.34	$93.67	$213.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $37.82 / $37.82	Facility	26	$37.82	$37.82	$37.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.79 / $141.81 / $308.27	Professional		$93.79	$141.81	$308.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.23 / $43.83 / $93.02	Professional	26	$29.23	$43.83	$93.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.06 / $99.84 / $220.05	Professional	TC	$67.06	$99.84	$220.05
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $99.36 / $139.65 / $188.53	Professional		$99.36	$139.65	$188.53
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.80 / $36.69 / $49.53	Professional	26	$30.80	$36.69	$49.53
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.56 / $102.96 / $139.00	Professional	TC	$68.56	$102.96	$139.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $105.69 / $139.01 / $230.88	Professional		$105.69	$139.01	$230.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.52 / $44.03 / $68.98	Professional	26	$32.52	$44.03	$68.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.37 / $119.07 / $193.06	Professional	TC	$82.37	$119.07	$193.06
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $78.25 / $162.16 / $162.16	Facility	26	$78.25	$162.16	$162.16
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $730.62 / $730.62 / $905.33	Professional		$730.62	$730.62	$905.33
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $210.44 / $210.44 / $267.68	Professional	26	$210.44	$210.44	$267.68
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $520.19 / $520.19 / $637.65	Professional	TC	$520.19	$520.19	$637.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $37.82 / $37.82	Facility	26	$37.82	$37.82	$37.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $99.05 / $154.84 / $308.27	Professional		$99.05	$154.84	$308.27
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.28 / $43.04 / $92.61	Professional	26	$29.28	$43.04	$92.61
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $68.67 / $99.29 / $220.05	Professional	TC	$68.67	$99.29	$220.05
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $362.12 / $362.12 / $362.12	Professional		$362.12	$362.12	$362.12
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $113.83 / $113.83 / $113.83	Professional	26	$113.83	$113.83	$113.83
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $248.29 / $248.29 / $248.29	Professional	TC	$248.29	$248.29	$248.29
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $112.93 / $139.10 / $168.91	Professional		$112.93	$139.10	$168.91
United Facility/Professional Professional Modifier Low / Median / High Price $86.97 / $118.97 / $280.86	Professional		$86.97	$118.97	$280.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $36.50 / $84.76	Professional	26	$28.14	$36.50	$84.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.83 / $82.79 / $230.83	Professional	TC	$58.83	$82.79	$230.83