Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.36 / $26.69 / $167.33	Facility	26	$25.36	$26.69	$167.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.52 / $99.77 / $508.00	Professional		$66.52	$99.77	$508.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $30.40 / $124.06	Professional	26	$24.78	$30.40	$124.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.50 / $55.33 / $316.00	Professional	TC	$42.50	$55.33	$316.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.02 / $108.79 / $272.00	Professional		$76.02	$108.79	$272.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.97 / $44.41 / $121.00	Professional	26	$21.97	$44.41	$121.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.51 / $105.89 / $213.27	Professional		$70.51	$105.89	$213.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.47 / $35.52 / $69.92	Professional	26	$26.47	$35.52	$69.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.29 / $69.73 / $135.44	Professional	TC	$44.29	$69.73	$135.44
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $38.70 / $52.25 / $187.99	Professional		$38.70	$52.25	$187.99
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.54 / $35.20 / $92.13	Professional	26	$25.54	$35.20	$92.13
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $13.11 / $17.12 / $100.00	Professional	TC	$13.11	$17.12	$100.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.27 / $31.27 / $31.27	Facility	26	$31.27	$31.27	$31.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.83 / $117.92 / $302.49	Professional		$61.83	$117.92	$302.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.90 / $32.86 / $76.83	Professional	26	$15.90	$32.86	$76.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.25 / $83.29 / $226.45	Professional	TC	$44.25	$83.29	$226.45
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $81.33 / $132.66 / $179.10	Professional		$81.33	$132.66	$179.10
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.96 / $30.48 / $41.15	Professional	26	$21.96	$30.48	$41.15
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.37 / $102.19 / $137.96	Professional	TC	$59.37	$102.19	$137.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $103.07 / $134.32 / $222.34	Professional		$103.07	$134.32	$222.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.99 / $36.58 / $62.10	Professional	26	$26.99	$36.58	$62.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.84 / $118.28 / $191.75	Professional	TC	$78.84	$118.28	$191.75
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $251.68 / $251.68 / $255.84	Facility	26	$251.68	$251.68	$255.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $659.39 / $659.39 / $857.33	Professional		$659.39	$659.39	$857.33
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $173.89 / $173.89 / $221.33	Professional	26	$173.89	$173.89	$221.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $485.50 / $485.50 / $636.00	Professional	TC	$485.50	$485.50	$636.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $69.17	Professional		$32.34	$32.34	$69.17
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $31.27 / $31.27 / $31.27	Facility	26	$31.27	$31.27	$31.27
Providence Facility/Professional Professional Modifier Low / Median / High Price $72.25 / $138.49 / $285.00	Professional		$72.25	$138.49	$285.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.09 / $31.49 / $76.31	Professional	26	$15.09	$31.49	$76.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.76 / $80.30 / $211.82	Professional	TC	$42.76	$80.30	$211.82
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $349.50 / $349.50 / $349.50	Professional		$349.50	$349.50	$349.50
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $93.99 / $93.99 / $93.99	Professional	26	$93.99	$93.99	$93.99
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $255.50 / $255.50 / $255.50	Professional	TC	$255.50	$255.50	$255.50
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $105.73 / $120.70 / $147.52	Professional		$105.73	$120.70	$147.52
United Facility/Professional Professional Modifier Low / Median / High Price $71.34 / $106.46 / $267.29	Professional		$71.34	$106.46	$267.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.89 / $29.59 / $69.56	Professional	26	$21.89	$29.59	$69.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.45 / $76.87 / $197.44	Professional	TC	$49.45	$76.87	$197.44