Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.28 / $25.44 / $154.38	Facility	26	$24.28	$25.44	$154.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.81 / $114.04 / $443.92	Professional		$82.81	$114.04	$443.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.76 / $28.76 / $132.66	Professional	26	$22.76	$28.76	$132.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.92 / $81.87 / $184.89	Professional	TC	$59.92	$81.87	$184.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $127.43 / $256.23 / $265.35	Professional		$127.43	$256.23	$265.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.54 / $28.46 / $56.63	Professional	26	$18.54	$28.46	$56.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.58 / $117.41 / $232.74	Professional		$85.58	$117.41	$232.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.42 / $34.97 / $67.83	Professional	26	$27.42	$34.97	$67.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.51 / $82.68 / $167.51	Professional	TC	$57.51	$82.68	$167.51
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.23 / $151.28 / $270.89	Professional		$100.23	$151.28	$270.89
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.50 / $31.13 / $71.66	Professional	26	$24.50	$31.13	$71.66
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $89.52 / $117.26 / $203.64	Professional	TC	$89.52	$117.26	$203.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.92 / $28.92 / $28.92	Facility	26	$28.92	$28.92	$28.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $88.51 / $135.02 / $352.38	Professional		$88.51	$135.02	$352.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.40 / $32.29 / $70.68	Professional	26	$22.40	$32.29	$70.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.58 / $103.35 / $290.83	Professional	TC	$63.58	$103.35	$290.83
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $51.91 / $160.60 / $216.81	Professional		$51.91	$160.60	$216.81
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.38 / $27.81 / $37.54	Professional	26	$10.38	$27.81	$37.54
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.53 / $132.79 / $179.27	Professional	TC	$41.53	$132.79	$179.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.05 / $157.57 / $279.00	Professional		$117.05	$157.57	$279.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.64 / $33.36 / $52.28	Professional	26	$24.64	$33.36	$52.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $106.23 / $153.54 / $248.98	Professional	TC	$106.23	$153.54	$248.98
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $122.88 / $122.88	Facility	26	$100.00	$122.88	$122.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $841.81 / $841.81 / $1,024.28	Professional		$841.81	$841.81	$1,024.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $202.73 / $205.77 / $205.77	Professional	26	$202.73	$205.77	$205.77
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $680.78 / $680.78 / $821.48	Professional	TC	$680.78	$680.78	$821.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $93.62	Professional		$32.34	$32.34	$93.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $28.92 / $28.92 / $28.92	Facility	26	$28.92	$28.92	$28.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $93.02 / $162.30 / $352.38	Professional		$93.02	$162.30	$352.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.49 / $31.73 / $70.05	Professional	26	$22.49	$31.73	$70.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $63.58 / $97.99 / $281.23	Professional	TC	$63.58	$97.99	$281.23
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $433.25 / $433.25 / $433.25	Professional		$433.25	$433.25	$433.25
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $86.39 / $86.39 / $86.39	Professional	26	$86.39	$86.39	$86.39
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $346.86 / $346.86 / $346.86	Professional	TC	$346.86	$346.86	$346.86
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $77.87 / $134.04 / $178.61	Professional		$77.87	$134.04	$178.61
United Facility/Professional Professional Modifier Low / Median / High Price $65.81 / $131.37 / $333.49	Professional		$65.81	$131.37	$333.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.47 / $27.82 / $67.56	Professional	26	$20.47	$27.82	$67.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.76 / $104.30 / $293.45	Professional	TC	$45.76	$104.30	$293.45