Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.81 / $44.38 / $247.26	Facility	26	$38.81	$44.38	$247.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.75 / $188.15 / $598.97	Professional		$93.75	$188.15	$598.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $67.84 / $239.00	Professional	26	$36.61	$67.84	$239.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.82 / $70.04 / $356.00	Professional	TC	$56.82	$70.04	$356.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $108.77 / $131.04 / $264.66	Professional		$108.77	$131.04	$264.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.31 / $50.21 / $82.29	Professional	26	$30.31	$50.21	$82.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $62.66 / $105.87 / $142.31	Professional	TC	$62.66	$105.87	$142.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.31 / $134.50 / $286.14	Professional		$96.31	$134.50	$286.14
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $53.50 / $111.98	Professional	26	$37.79	$53.50	$111.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.92 / $81.86 / $174.16	Professional	TC	$57.92	$81.86	$174.16
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $77.93 / $100.00 / $249.90	Professional		$77.93	$100.00	$249.90
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.97 / $37.32 / $100.00	Professional	26	$28.97	$37.32	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $48.97 / $65.30 / $163.28	Professional	TC	$48.97	$65.30	$163.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.25 / $46.25 / $46.25	Facility	26	$46.25	$46.25	$46.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.12 / $144.25 / $330.19	Professional		$96.12	$144.25	$330.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.51 / $53.49 / $117.96	Professional	26	$36.51	$53.49	$117.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.96 / $92.39 / $214.12	Professional	TC	$55.96	$92.39	$214.12
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $51.84 / $139.13 / $187.83	Professional		$51.84	$139.13	$187.83
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.66 / $45.35 / $61.22	Professional	26	$18.66	$45.35	$61.22
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.18 / $93.78 / $126.60	Professional	TC	$33.18	$93.78	$126.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.72 / $140.66 / $265.87	Professional		$102.72	$140.66	$265.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.90 / $56.36 / $94.83	Professional	26	$39.90	$56.36	$94.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.02 / $110.00 / $183.91	Professional	TC	$75.02	$110.00	$183.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $95.69 / $181.68 / $198.74	Facility	26	$95.69	$181.68	$198.74
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $708.49 / $708.49 / $902.10	Professional		$708.49	$708.49	$902.10
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $257.68 / $257.68 / $321.00	Professional	26	$257.68	$257.68	$321.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $450.80 / $450.80 / $581.10	Professional	TC	$450.80	$450.80	$581.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $76.77	Professional		$32.34	$32.34	$76.77
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $46.25 / $46.25 / $46.25	Facility	26	$46.25	$46.25	$46.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $98.04 / $153.47 / $319.39	Professional		$98.04	$153.47	$319.39
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.19 / $51.60 / $117.23	Professional	26	$37.19	$51.60	$117.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $55.96 / $87.51 / $211.53	Professional	TC	$55.96	$87.51	$211.53
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $376.99 / $376.99 / $376.99	Professional		$376.99	$376.99	$376.99
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $138.32 / $138.32 / $138.32	Professional	26	$138.32	$138.32	$138.32
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $238.67 / $238.67 / $238.67	Professional	TC	$238.67	$238.67	$238.67
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $77.76 / $118.31 / $154.72	Professional		$77.76	$118.31	$154.72
United Facility/Professional Professional Modifier Low / Median / High Price $78.16 / $117.08 / $346.21	Professional		$78.16	$117.08	$346.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.41 / $43.31 / $109.70	Professional	26	$30.41	$43.31	$109.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.75 / $71.81 / $201.93	Professional	TC	$47.75	$71.81	$201.93