Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.56 / $36.21 / $221.26	Facility	26	$34.56	$36.21	$221.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.88 / $160.13 / $592.50	Professional		$130.88	$160.13	$592.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.98 / $39.13 / $167.70	Professional	26	$31.98	$39.13	$167.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.68 / $122.73 / $329.68	Professional	TC	$99.68	$122.73	$329.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $207.21 / $207.21 / $783.62	Professional		$207.21	$207.21	$783.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.45 / $72.45 / $80.90	Professional	26	$72.45	$72.45	$80.90
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $137.66 / $186.72 / $390.12	Professional		$137.66	$186.72	$390.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.43 / $51.37 / $101.86	Professional	26	$36.43	$51.37	$101.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.93 / $137.71 / $288.26	Professional	TC	$100.93	$137.71	$288.26
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $146.91 / $367.37	Professional		$100.00	$146.91	$367.37
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $29.47 / $37.22 / $100.00	Professional	26	$29.47	$37.22	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $83.68 / $111.21 / $278.98	Professional	TC	$83.68	$111.21	$278.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.92 / $40.92 / $40.92	Facility	26	$40.92	$40.92	$40.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.27 / $195.87 / $456.82	Professional		$131.27	$195.87	$456.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.75 / $46.23 / $102.46	Professional	26	$31.75	$46.23	$102.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.45 / $148.72 / $352.73	Professional	TC	$96.45	$148.72	$352.73
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $110.40 / $191.01 / $257.86	Professional		$110.40	$191.01	$257.86
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.39 / $39.72 / $53.62	Professional	26	$25.39	$39.72	$53.62
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.01 / $151.30 / $204.26	Professional	TC	$85.01	$151.30	$204.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.18 / $192.97 / $387.00	Professional		$147.18	$192.97	$387.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.20 / $49.59 / $83.44	Professional	26	$35.20	$49.59	$83.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $121.04 / $177.48 / $296.75	Professional	TC	$121.04	$177.48	$296.75
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $84.74 / $161.97 / $175.47	Facility	26	$84.74	$161.97	$175.47
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $968.58 / $968.58 / $1,227.45	Professional		$968.58	$968.58	$1,227.45
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $227.63 / $227.63 / $288.83	Professional	26	$227.63	$227.63	$288.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $740.95 / $740.95 / $938.70	Professional	TC	$740.95	$740.95	$938.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $103.80	Professional		$32.34	$32.34	$103.80
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $40.92 / $40.92 / $40.92	Facility	26	$40.92	$40.92	$40.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $134.24 / $209.33 / $437.08	Professional		$134.24	$209.33	$437.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.75 / $44.70 / $101.19	Professional	26	$31.75	$44.70	$101.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $96.21 / $143.51 / $345.01	Professional	TC	$96.21	$143.51	$345.01
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $522.44 / $522.44 / $522.44	Professional		$522.44	$522.44	$522.44
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $124.44 / $124.44 / $124.44	Professional	26	$124.44	$124.44	$124.44
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $398.00 / $398.00 / $398.00	Professional	TC	$398.00	$398.00	$398.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $143.52 / $165.60 / $212.41	Professional		$143.52	$165.60	$212.41
United Facility/Professional Professional Modifier Low / Median / High Price $103.45 / $159.16 / $472.37	Professional		$103.45	$159.16	$472.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.29 / $39.34 / $103.08	Professional	26	$27.29	$39.34	$103.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.16 / $119.82 / $310.45	Professional	TC	$76.16	$119.82	$310.45