Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $40.74 / $114.82	Facility	26	$30.90	$40.74	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $173.78 / $630.96	Professional		$109.65	$173.78	$630.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $57.54 / $154.88	Professional	26	$30.90	$57.54	$154.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $102.33 / $288.40	Professional	TC	$79.43	$102.33	$288.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $177.83 / $263.03	Professional		$120.23	$177.83	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $77.62 / $162.18	Professional	26	$43.65	$77.62	$162.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $154.88 / $338.84	Professional		$120.23	$154.88	$338.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $50.12 / $100.00	Professional	26	$37.15	$50.12	$100.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $107.15 / $234.42	Professional	TC	$79.43	$107.15	$234.42
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $186.21 / $354.81	Professional		$141.25	$186.21	$354.81
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $50.12 / $97.72	Professional	26	$38.02	$50.12	$97.72
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $138.04 / $263.03	Professional	TC	$102.33	$138.04	$263.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $47.86 / $69.18	Facility	26	$10.23	$47.86	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $162.18 / $316.23	Professional		$109.65	$162.18	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $45.71 / $97.72	Professional	26	$30.90	$45.71	$97.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $114.82 / $251.19	Professional	TC	$75.86	$114.82	$251.19
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $177.83 / $239.88	Professional		$114.82	$177.83	$239.88
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $47.86 / $64.57	Professional	26	$30.20	$47.86	$64.57
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $131.83 / $177.83	Professional	TC	$85.11	$131.83	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $295.12	Professional		$131.83	$169.82	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $54.95 / $91.20	Professional	26	$42.66	$54.95	$91.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $141.25 / $245.47	Professional	TC	$107.15	$141.25	$245.47
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $269.15 / $269.15 / $269.15	Facility	26	$269.15	$269.15	$269.15
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,148.15 / $1,148.15	Professional		$933.25	$1,148.15	$1,148.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $338.84 / $338.84	Professional	26	$269.15	$338.84	$338.84
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $794.33 / $794.33	Professional	TC	$660.69	$794.33	$794.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $50.12 / $158.49	Professional		$32.36	$50.12	$158.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $47.86 / $69.18	Facility	26	$10.23	$47.86	$69.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $169.82 / $354.81	Professional		$109.65	$169.82	$354.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $43.65 / $89.13	Professional	26	$30.90	$43.65	$89.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $109.65 / $234.42	Professional	TC	$74.13	$109.65	$234.42
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $457.09 / $457.09	Professional		$457.09	$457.09	$457.09
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $147.91 / $147.91	Professional	26	$147.91	$147.91	$147.91
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 $128.82 / $151.36 / $177.83	Professional		$128.82	$151.36	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $141.25 / $295.12	Professional		$87.10	$141.25	$295.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $45.71 / $91.20	Professional	26	$26.92	$45.71	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $95.50 / $208.93	Professional	TC	$63.10	$95.50	$208.93