Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.71 / $17.43 / $273.05	Facility	26	$16.71	$17.43	$273.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.89 / $163.13 / $323.38	Professional		$87.89	$163.13	$323.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.71 / $32.70 / $171.22	Professional	26	$15.71	$32.70	$171.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.43 / $146.43 / $299.19	Professional	TC	$47.43	$146.43	$299.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.61 / $95.00 / $95.00	Professional	26	$34.61	$95.00	$95.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.97 / $214.70 / $510.71	Professional		$104.97	$214.70	$510.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.23 / $29.10 / $243.16	Professional	26	$18.23	$29.10	$243.16
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.13 / $190.43 / $428.93	Professional	TC	$60.13	$190.43	$428.93
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $120.04 / $197.18 / $431.75	Professional		$120.04	$197.18	$431.75
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.77 / $19.02 / $55.62	Professional	26	$15.77	$19.02	$55.62
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $107.78 / $178.32 / $387.07	Professional	TC	$107.78	$178.32	$387.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.72 / $52.72 / $52.72	Facility	26	$52.72	$52.72	$52.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.48 / $174.64 / $621.77	Professional		$80.48	$174.64	$621.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.71 / $29.85 / $93.17	Professional	26	$17.71	$29.85	$93.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.32 / $132.19 / $543.91	Professional	TC	$55.32	$132.19	$543.91
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $75.52 / $118.40 / $159.84	Professional		$75.52	$118.40	$159.84
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.35 / $49.40 / $66.69	Professional	26	$14.35	$49.40	$66.69
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.17 / $68.98 / $93.14	Professional	TC	$61.17	$68.98	$93.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $88.88 / $118.40 / $216.41	Professional		$88.88	$118.40	$216.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.29 / $59.79 / $92.87	Professional	26	$44.29	$59.79	$92.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $55.19 / $79.81 / $129.41	Professional	TC	$55.19	$79.81	$129.41
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $108.25 / $220.50 / $220.50	Facility	26	$108.25	$220.50	$220.50
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,899.89 / $2,986.89 / $2,986.89	Professional		$2,899.89	$2,986.89	$2,986.89
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $425.60 / $425.60 / $425.60	Professional	26	$425.60	$425.60	$425.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,808.09 / $2,892.33 / $2,892.33	Professional	TC	$2,808.09	$2,892.33	$2,892.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $61.05	Professional		$32.34	$32.34	$61.05
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $52.72 / $52.72 / $52.72	Facility	26	$52.72	$52.72	$52.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $86.59 / $196.09 / $553.64	Professional		$86.59	$196.09	$553.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.91 / $27.05 / $83.71	Professional	26	$17.91	$27.05	$83.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $145.80 / $577.86	Professional	TC	$56.23	$145.80	$577.86
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $354.83 / $354.83 / $354.83	Professional		$354.83	$354.83	$354.83
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $155.83 / $155.83 / $155.83	Professional	26	$155.83	$155.83	$155.83
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $199.00 / $199.00 / $199.00	Professional	TC	$199.00	$199.00	$199.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $95.72 / $131.62 / $588.33	Professional		$95.72	$131.62	$588.33
United Facility/Professional Professional Modifier Low / Median / High Price $102.31 / $138.47 / $407.86	Professional		$102.31	$138.47	$407.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.11 / $49.80 / $107.25	Professional	26	$14.11	$49.80	$107.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.91 / $90.36 / $323.29	Professional	TC	$59.91	$90.36	$323.29