Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $57.54 / $128.82	Facility	26	$44.67	$57.54	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $239.88 / $691.83	Professional		$131.83	$239.88	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $89.13 / $213.80	Professional	26	$42.66	$89.13	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $117.49 / $363.08	Professional	TC	$77.62	$117.49	$363.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $138.04 / $229.09	Professional		$104.71	$138.04	$229.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $75.86 / $112.20	Professional	26	$38.02	$75.86	$112.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $109.65 / $181.97	Professional	TC	$56.23	$109.65	$181.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $190.55 / $389.05	Professional		$144.54	$190.55	$389.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $69.18 / $125.89	Professional	26	$51.29	$69.18	$125.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $123.03 / $251.19	Professional	TC	$93.33	$123.03	$251.19
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $190.55 / $389.05	Professional		$128.82	$190.55	$389.05
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $70.79 / $131.83	Professional	26	$48.98	$70.79	$131.83
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $120.23 / $245.47	Professional	TC	$79.43	$120.23	$245.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $77.62	Facility	26	$11.48	$53.70	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $186.21 / $346.74	Professional		$123.03	$186.21	$346.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $63.10 / $120.23	Professional	26	$42.66	$63.10	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $123.03 / $245.47	Professional	TC	$79.43	$123.03	$245.47
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $177.83 / $239.88	Professional		$93.33	$177.83	$239.88
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $54.95 / $74.13	Professional	26	$30.90	$54.95	$74.13
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $125.89 / $169.82	Professional	TC	$63.10	$125.89	$169.82
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $812.83	Professional		$812.83	$812.83	$812.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $316.23	Professional		$131.83	$169.82	$316.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $64.57 / $114.82	Professional	26	$47.86	$64.57	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $141.25 / $239.88	Professional	TC	$97.72	$141.25	$239.88
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	26	$295.12	$295.12	$295.12
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $870.96 / $1,122.02	Professional		$181.97	$870.96	$1,122.02
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $295.12 / $380.19 / $380.19	Professional	26	$295.12	$380.19	$380.19
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $741.31 / $741.31	Professional	TC	$575.44	$741.31	$741.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $97.72 / $154.88	Professional		$63.10	$97.72	$154.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $77.62	Facility	26	$11.48	$53.70	$77.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $190.55 / $363.08	Professional		$123.03	$190.55	$363.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $60.26 / $117.49	Professional	26	$41.69	$60.26	$117.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $120.23 / $245.47	Professional	TC	$79.43	$120.23	$245.47
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $467.74 / $467.74	Professional		$467.74	$467.74	$467.74
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	26	$162.18	$162.18	$162.18
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $302.00 / $302.00	Professional	TC	$302.00	$302.00	$302.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $177.83 / $229.09	Professional		$141.25	$177.83	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $141.25 / $295.12	Professional		$107.15	$141.25	$295.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $51.29 / $102.33	Professional	26	$34.67	$51.29	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $91.20 / $199.53	Professional	TC	$70.79	$91.20	$199.53