Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.37 / $28.17 / $167.33	Facility	26	$26.37	$28.17	$167.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.66 / $112.66 / $480.00	Professional		$64.66	$112.66	$480.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.26 / $33.72 / $122.74	Professional	26	$25.26	$33.72	$122.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.27 / $85.82 / $161.88	Professional	TC	$31.27	$85.82	$161.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $37.56 / $56.77 / $79.01	Professional		$37.56	$56.77	$79.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.30 / $26.09 / $62.04	Professional	26	$20.30	$26.09	$62.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $84.41 / $134.57 / $243.83	Professional		$84.41	$134.57	$243.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.60 / $40.47 / $78.98	Professional	26	$30.60	$40.47	$78.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.20 / $94.50 / $144.65	Professional	TC	$47.20	$94.50	$144.65
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $80.34 / $103.90 / $239.83	Professional		$80.34	$103.90	$239.83
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.65 / $27.89 / $75.38	Professional	26	$21.65	$27.89	$75.38
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $58.70 / $78.26 / $172.69	Professional	TC	$58.70	$78.26	$172.69
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 $51.69 / $103.56 / $203.52	Professional		$51.69	$103.56	$203.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.17 / $36.14 / $77.06	Professional	26	$24.17	$36.14	$77.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.83 / $61.54 / $129.32	Professional	TC	$26.83	$61.54	$129.32
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $51.38 / $76.06 / $102.69	Professional		$51.38	$76.06	$102.69
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.15 / $30.48 / $41.15	Professional	26	$24.15	$30.48	$41.15
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.23 / $45.58 / $61.53	Professional	TC	$27.23	$45.58	$61.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $59.63 / $78.25 / $139.00	Professional		$59.63	$78.25	$139.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.99 / $38.04 / $64.03	Professional	26	$26.99	$38.04	$64.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.46 / $53.50 / $89.47	Professional	TC	$36.46	$53.50	$89.47
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.90 / $124.11 / $134.57	Facility	26	$85.90	$124.11	$134.57
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $505.35 / $562.97 / $562.97	Professional		$505.35	$562.97	$562.97
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $186.58 / $186.58 / $221.33	Professional	26	$186.58	$186.58	$221.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $342.11 / $399.92 / $399.92	Professional	TC	$342.11	$399.92	$399.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $34.95	Professional		$32.34	$32.34	$34.95
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 $53.68 / $110.51 / $173.40	Professional		$53.68	$110.51	$173.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.29 / $34.65 / $76.62	Professional	26	$24.29	$34.65	$76.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.83 / $62.03 / $122.46	Professional	TC	$26.83	$62.03	$122.46
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $194.42 / $194.42 / $194.42	Professional		$194.42	$194.42	$194.42
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 $100.42 / $100.42 / $100.42	Professional	TC	$100.42	$100.42	$100.42
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $61.50 / $84.57 / $147.46	Professional		$61.50	$84.57	$147.46
United Facility/Professional Professional Modifier Low / Median / High Price $58.72 / $74.75 / $194.63	Professional		$58.72	$74.75	$194.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.04 / $29.59 / $81.81	Professional	26	$21.04	$29.59	$81.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.15 / $44.29 / $102.91	Professional	TC	$30.15	$44.29	$102.91