Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.67 / $35.60 / $211.45	Facility	26	$32.67	$35.60	$211.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.23 / $119.11 / $482.00	Professional		$91.23	$119.11	$482.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.13 / $35.93 / $156.04	Professional	26	$31.13	$35.93	$156.04
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $119.27 / $281.58 / $807.00	Professional	50	$119.27	$281.58	$807.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.92 / $71.56 / $202.41	Professional	TC	$62.92	$71.56	$202.41
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.45 / $102.40 / $179.73	Professional		$72.45	$102.40	$179.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.67 / $46.76 / $118.03	Professional	26	$29.67	$46.76	$118.03
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $108.69 / $145.07 / $217.04	Professional	50	$108.69	$145.07	$217.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $103.81 / $123.42 / $156.47	Professional	TC	$103.81	$123.42	$156.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $187.86 / $350.96	Professional		$117.49	$187.86	$350.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.61 / $58.88 / $112.46	Professional	26	$38.61	$58.88	$112.46
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $128.10 / $163.40 / $198.03	Professional	50	$128.10	$163.40	$198.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.20 / $129.25 / $241.48	Professional	TC	$78.20	$129.25	$241.48
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $130.25 / $308.29	Professional		$100.00	$130.25	$308.29
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.02 / $41.97 / $100.00	Professional	26	$34.02	$41.97	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $69.70 / $92.47 / $213.50	Professional	TC	$69.70	$92.47	$213.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $39.72 / $39.72	Facility	26	$39.72	$39.72	$39.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.70 / $143.38 / $316.08	Professional		$97.70	$143.38	$316.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.85 / $46.63 / $100.59	Professional	26	$31.85	$46.63	$100.59
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $157.99 / $157.99 / $157.99	Professional	50	$157.99	$157.99	$157.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.13 / $96.62 / $214.60	Professional	TC	$65.13	$96.62	$214.60
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $96.23 / $131.06 / $176.93	Professional		$96.23	$131.06	$176.93
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.79 / $38.65 / $52.19	Professional	26	$30.79	$38.65	$52.19
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.44 / $92.40 / $124.74	Professional	TC	$65.44	$92.40	$124.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $101.28 / $132.69 / $265.00	Professional		$101.28	$132.69	$265.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.21 / $48.24 / $81.19	Professional	26	$34.21	$48.24	$81.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.92 / $108.38 / $181.22	Professional	TC	$73.92	$108.38	$181.22
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $82.13 / $157.44 / $170.67	Facility	26	$82.13	$157.44	$170.67
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $667.61 / $667.61 / $853.65	Professional		$667.61	$667.61	$853.65
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $219.03 / $219.03 / $281.02	Professional	26	$219.03	$219.03	$281.02
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $448.58 / $448.58 / $572.54	Professional	TC	$448.58	$448.58	$572.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $76.03	Professional		$32.34	$32.34	$76.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $39.72 / $39.72 / $39.72	Facility	26	$39.72	$39.72	$39.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $98.80 / $163.78 / $309.35	Professional		$98.80	$163.78	$309.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.86 / $45.83 / $98.62	Professional	26	$31.86	$45.83	$98.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $66.68 / $95.84 / $211.53	Professional	TC	$66.68	$95.84	$211.53
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $357.16 / $357.16 / $357.16	Professional		$357.16	$357.16	$357.16
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $118.49 / $118.49 / $118.49	Professional	26	$118.49	$118.49	$118.49
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $238.67 / $238.67 / $238.67	Professional	TC	$238.67	$238.67	$238.67
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $105.98 / $134.72 / $163.58	Professional		$105.98	$134.72	$163.58
United Facility/Professional Professional Modifier Low / Median / High Price $84.62 / $108.99 / $321.27	Professional		$84.62	$108.99	$321.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.04 / $37.17 / $92.46	Professional	26	$29.04	$37.17	$92.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.58 / $71.81 / $205.21	Professional	TC	$55.58	$71.81	$205.21