Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $40.74 / $162.18	Facility	26	$25.12	$40.74	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $134.90 / $524.81	Professional		$85.11	$134.90	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $36.31 / $112.20	Professional	26	$23.99	$36.31	$112.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $87.10 / $331.13	Professional	TC	$61.66	$87.10	$331.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $120.23 / $204.17	Professional		$70.79	$120.23	$204.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $57.54 / $114.82	Professional	26	$44.67	$57.54	$114.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $186.21 / $186.21	Professional	TC	$186.21	$186.21	$186.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $186.21 / $346.74	Professional		$141.25	$186.21	$346.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $51.29 / $85.11	Professional	26	$37.15	$51.29	$85.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $138.04 / $251.19	Professional	TC	$102.33	$138.04	$251.19
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $151.36 / $309.03	Professional		$107.15	$151.36	$309.03
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $42.66 / $81.28	Professional	26	$30.20	$42.66	$81.28
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $109.65 / $229.09	Professional	TC	$75.86	$109.65	$229.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.31 / $29.51 / $41.69	Facility	26	$6.31	$29.51	$41.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $131.83 / $257.04	Professional		$89.13	$131.83	$257.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $35.48 / $64.57	Professional	26	$23.44	$35.48	$64.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $97.72 / $199.53	Professional	TC	$64.57	$97.72	$199.53
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $141.25 / $190.55	Professional		$85.11	$141.25	$190.55
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $29.51 / $39.81	Professional	26	$23.99	$29.51	$39.81
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $112.20 / $151.36	Professional	TC	$61.66	$112.20	$151.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $131.83 / $229.09	Professional		$104.71	$131.83	$229.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $35.48 / $61.66	Professional	26	$26.30	$35.48	$61.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $125.89 / $218.78	Professional	TC	$87.10	$125.89	$218.78
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $165.96 / $165.96	Facility	26	$165.96	$165.96	$165.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $891.25 / $891.25	Professional		$691.83	$891.25	$891.25
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $208.93 / $208.93	Professional	26	$165.96	$208.93	$208.93
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $691.83 / $691.83	Professional	TC	$524.81	$691.83	$691.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $89.13 / $120.23	Professional		$30.90	$89.13	$120.23
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $6.31 / $29.51 / $41.69	Facility	26	$6.31	$29.51	$41.69
Providence Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $141.25 / $275.42	Professional		$91.20	$141.25	$275.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $34.67 / $63.10	Professional	26	$22.91	$34.67	$63.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $93.33 / $194.98	Professional	TC	$64.57	$93.33	$194.98
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $380.19	Professional		$380.19	$380.19	$380.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Professional	26	$89.13	$89.13	$89.13
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	TC	$288.40	$288.40	$288.40
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $120.23 / $154.88	Professional		$85.11	$120.23	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $114.82 / $239.88	Professional		$81.28	$114.82	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $28.18 / $56.23	Professional	26	$20.89	$28.18	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $87.10 / $186.21	Professional	TC	$58.88	$87.10	$186.21