Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.23 / $34.93 / $774.75	Facility	26	$29.23	$34.93	$774.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.59 / $154.88 / $482.90	Professional		$82.59	$154.88	$482.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.91 / $53.87 / $168.01	Professional	26	$27.91	$53.87	$168.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.36 / $67.39 / $259.45	Professional	TC	$52.36	$67.39	$259.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.18 / $89.62 / $196.27	Professional		$76.18	$89.62	$196.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.81 / $30.26 / $62.51	Professional	26	$22.81	$30.26	$62.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $57.77 / $57.77 / $57.77	Professional	TC	$57.77	$57.77	$57.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $90.70 / $119.79 / $239.17	Professional		$90.70	$119.79	$239.17
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.79 / $43.97 / $85.17	Professional	26	$33.79	$43.97	$85.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.79 / $77.12 / $154.00	Professional	TC	$56.79	$77.12	$154.00
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $77.26 / $100.00 / $234.60	Professional		$77.26	$100.00	$234.60
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $29.27 / $36.75 / $100.00	Professional	26	$29.27	$36.75	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $47.99 / $63.76 / $150.41	Professional	TC	$47.99	$63.76	$150.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.11 / $35.11 / $35.11	Facility	26	$35.11	$35.11	$35.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.43 / $115.10 / $244.23	Professional		$76.43	$115.10	$244.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.29 / $40.86 / $90.08	Professional	26	$28.29	$40.86	$90.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.08 / $75.01 / $160.81	Professional	TC	$48.08	$75.01	$160.81
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $62.95 / $102.86 / $138.86	Professional		$62.95	$102.86	$138.86
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.29 / $34.32 / $46.33	Professional	26	$23.29	$34.32	$46.33
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.65 / $68.53 / $92.52	Professional	TC	$39.65	$68.53	$92.52
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $80.65 / $80.65 / $168.04	Professional		$80.65	$80.65	$168.04
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $64.75 / $64.75 / $64.75	Professional	26	$64.75	$64.75	$64.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $80.66 / $104.58 / $197.16	Professional		$80.66	$104.58	$197.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.89 / $42.80 / $74.81	Professional	26	$30.89	$42.80	$74.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $55.90 / $81.93 / $149.40	Professional	TC	$55.90	$81.93	$149.40
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.90 / $139.28 / $151.29	Facility	26	$85.90	$139.28	$151.29
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $524.64 / $524.64 / $673.35	Professional		$524.64	$524.64	$673.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $195.35 / $195.35 / $247.88	Professional	26	$195.35	$195.35	$247.88
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $329.23 / $329.23 / $425.48	Professional	TC	$329.23	$329.23	$425.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $64.03	Professional		$32.34	$32.34	$64.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $35.11 / $35.11 / $35.11	Facility	26	$35.11	$35.11	$35.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.15 / $124.41 / $240.12	Professional		$77.15	$124.41	$240.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.43 / $39.83 / $87.90	Professional	26	$28.43	$39.83	$87.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $48.08 / $72.12 / $158.01	Professional	TC	$48.08	$72.12	$158.01
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $279.42 / $279.42 / $279.42	Professional		$279.42	$279.42	$279.42
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $105.67 / $105.67 / $105.67	Professional	26	$105.67	$105.67	$105.67
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $173.75 / $173.75 / $173.75	Professional	TC	$173.75	$173.75	$173.75
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $114.37 / $153.51	Professional		$83.18	$114.37	$153.51
United Facility/Professional Professional Modifier Low / Median / High Price $66.65 / $85.57 / $226.03	Professional		$66.65	$85.57	$226.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.02 / $33.20 / $87.80	Professional	26	$23.02	$33.20	$87.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.31 / $52.64 / $147.02	Professional	TC	$42.31	$52.64	$147.02