Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.76 / $33.27 / $260.95	Facility	26	$31.76	$33.27	$260.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.14 / $135.71 / $629.73	Professional		$109.14	$135.71	$629.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $41.92 / $152.07	Professional	26	$29.91	$41.92	$152.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.23 / $94.47 / $239.03	Professional	TC	$79.23	$94.47	$239.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.68 / $178.89 / $178.89	Professional		$112.68	$178.89	$178.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.19 / $41.47 / $161.36	Professional	26	$25.19	$41.47	$161.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.74 / $151.11 / $303.49	Professional		$112.74	$151.11	$303.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.72 / $46.27 / $93.12	Professional	26	$36.72	$46.27	$93.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $73.50 / $104.46 / $217.04	Professional	TC	$73.50	$104.46	$217.04
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.45 / $154.28 / $335.98	Professional		$100.45	$154.28	$335.98
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.61 / $40.53 / $100.00	Professional	26	$32.61	$40.53	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $93.26 / $114.77 / $245.61	Professional	TC	$93.26	$114.77	$245.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.64 / $48.64 / $48.64	Facility	26	$48.64	$48.64	$48.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.25 / $163.62 / $385.62	Professional		$109.25	$163.62	$385.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.08 / $45.92 / $101.20	Professional	26	$31.08	$45.92	$101.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.56 / $117.27 / $278.66	Professional	TC	$76.56	$117.27	$278.66
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $115.25 / $176.52 / $238.30	Professional		$115.25	$176.52	$238.30
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.97 / $46.94 / $63.37	Professional	26	$29.97	$46.94	$63.37
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.29 / $129.58 / $174.93	Professional	TC	$85.29	$129.58	$174.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $133.58 / $175.63 / $291.70	Professional		$133.58	$175.63	$291.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.56 / $56.33 / $88.25	Professional	26	$41.56	$56.33	$88.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $103.66 / $149.82 / $242.95	Professional	TC	$103.66	$149.82	$242.95
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.12 / $207.05 / $207.05	Facility	26	$100.12	$207.05	$207.05
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $927.52 / $927.52 / $1,140.83	Professional		$927.52	$927.52	$1,140.83
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $268.38 / $268.38 / $339.15	Professional	26	$268.38	$268.38	$339.15
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $659.08 / $659.08 / $801.68	Professional	TC	$659.08	$659.08	$801.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $91.18	Professional		$32.34	$32.34	$91.18
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $48.64 / $48.64 / $48.64	Facility	26	$48.64	$48.64	$48.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $116.46 / $186.18 / $386.35	Professional		$116.46	$186.18	$386.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.27 / $44.98 / $97.00	Professional	26	$33.27	$44.98	$97.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $76.33 / $113.08 / $270.63	Professional	TC	$76.33	$113.08	$270.63
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $460.99 / $460.99 / $460.99	Professional		$460.99	$460.99	$460.99
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $146.58 / $146.58 / $146.58	Professional	26	$146.58	$146.58	$146.58
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $314.39 / $314.39 / $314.39	Professional	TC	$314.39	$314.39	$314.39
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $129.07 / $160.61 / $196.30	Professional		$129.07	$160.61	$196.30
United Facility/Professional Professional Modifier Low / Median / High Price $87.54 / $140.75 / $465.38	Professional		$87.54	$140.75	$465.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.83 / $46.19 / $113.57	Professional	26	$26.83	$46.19	$113.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.15 / $98.43 / $274.44	Professional	TC	$64.15	$98.43	$274.44