Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $35.48 / $74.13	Facility	26	$25.12	$35.48	$74.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $131.83 / $537.03	Professional		$69.18	$131.83	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $38.90 / $112.20	Professional	26	$24.55	$38.90	$112.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $83.18 / $338.84	Professional	TC	$42.66	$83.18	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $102.33 / $269.15	Professional		$81.28	$102.33	$269.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $51.29 / $64.57	Professional	26	$28.18	$51.29	$64.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $154.88 / $154.88	Professional	TC	$154.88	$154.88	$154.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $112.20 / $245.47	Professional		$79.43	$112.20	$245.47
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $38.02 / $74.13	Professional	26	$27.54	$38.02	$74.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $72.44 / $177.83	Professional	TC	$51.29	$72.44	$177.83
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $74.13 / $204.17	Professional		$47.86	$74.13	$204.17
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $45.71 / $85.11	Professional	26	$33.11	$45.71	$85.11
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $24.55 / $114.82	Professional	TC	$15.14	$24.55	$114.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	26	$6.76	$31.62	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $128.82 / $275.42	Professional		$72.44	$128.82	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $34.67 / $72.44	Professional	26	$19.50	$34.67	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $91.20 / $204.17	Professional	TC	$53.70	$91.20	$204.17
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $131.83 / $177.83	Professional		$81.28	$131.83	$177.83
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $30.90 / $41.69	Professional	26	$21.88	$30.90	$41.69
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $102.33 / $138.04	Professional	TC	$58.88	$102.33	$138.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $128.82 / $218.78	Professional		$97.72	$128.82	$218.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $35.48 / $57.54	Professional	26	$26.92	$35.48	$57.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $112.20 / $186.21	Professional	TC	$85.11	$112.20	$186.21
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $251.19 / $251.19 / $251.19	Facility	26	$251.19	$251.19	$251.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $851.14 / $851.14	Professional		$660.69	$851.14	$851.14
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $223.87 / $223.87	Professional	26	$173.78	$223.87	$223.87
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $630.96 / $630.96	Professional	TC	$489.78	$630.96	$630.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $117.49	Professional		$32.36	$33.11	$117.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	26	$6.76	$31.62	$44.67
Providence Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $134.90 / $275.42	Professional		$72.44	$134.90	$275.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $31.62 / $69.18	Professional	26	$16.22	$31.62	$69.18
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $83.18 / $190.55	Professional	TC	$48.98	$83.18	$190.55
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $346.74 / $346.74	Professional		$346.74	$346.74	$346.74
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	26	$93.33	$93.33	$93.33
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $257.04 / $257.04	Professional	TC	$257.04	$257.04	$257.04
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $114.82 / $147.91	Professional		$81.28	$114.82	$147.91
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $100.00 / $223.87	Professional		$70.79	$100.00	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $28.18 / $58.88	Professional	26	$21.88	$28.18	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $74.13 / $165.96	Professional	TC	$48.98	$74.13	$165.96