Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.04 / $41.95 / $217.83	Facility	26	$34.04	$41.95	$217.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.95 / $169.76 / $512.00	Professional		$88.95	$169.76	$512.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.13 / $59.01 / $189.00	Professional	26	$32.13	$59.01	$189.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.47 / $69.69 / $245.50	Professional	TC	$54.47	$69.69	$245.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.38 / $117.15 / $250.93	Professional		$85.38	$117.15	$250.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.32 / $38.50 / $80.50	Professional	26	$26.32	$38.50	$80.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $87.25 / $87.25 / $87.25	Professional	TC	$87.25	$87.25	$87.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.74 / $135.47 / $270.52	Professional		$103.74	$135.47	$270.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.43 / $51.69 / $101.46	Professional	26	$39.43	$51.69	$101.46
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.05 / $85.04 / $171.13	Professional	TC	$64.05	$85.04	$171.13
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $84.28 / $105.86 / $255.15	Professional		$84.28	$105.86	$255.15
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.49 / $42.05 / $100.00	Professional	26	$33.49	$42.05	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $50.79 / $67.69 / $158.93	Professional	TC	$50.79	$67.69	$158.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.86 / $40.86 / $40.86	Facility	26	$40.86	$40.86	$40.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.29 / $128.72 / $279.56	Professional		$87.29	$128.72	$279.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.74 / $47.18 / $104.59	Professional	26	$32.74	$47.18	$104.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.05 / $82.57 / $182.87	Professional	TC	$55.05	$82.57	$182.87
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $82.17 / $116.93 / $157.86	Professional		$82.17	$116.93	$157.86
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.40 / $39.68 / $53.57	Professional	26	$30.40	$39.68	$53.57
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.77 / $77.26 / $104.30	Professional	TC	$51.77	$77.26	$104.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $90.00 / $118.53 / $224.11	Professional		$90.00	$118.53	$224.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.04 / $49.44 / $83.19	Professional	26	$35.04	$49.44	$83.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $61.81 / $90.63 / $151.52	Professional	TC	$61.81	$90.63	$151.52
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $84.15 / $163.00 / $174.61	Facility	26	$84.15	$163.00	$174.61
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $600.27 / $600.27 / $764.25	Professional		$600.27	$600.27	$764.25
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $233.19 / $240.89 / $285.00	Professional	26	$233.19	$240.89	$285.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $372.64 / $372.64 / $479.25	Professional	TC	$372.64	$372.64	$479.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $67.43	Professional		$32.34	$32.34	$67.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $40.86 / $40.86 / $40.86	Facility	26	$40.86	$40.86	$40.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $88.70 / $141.02 / $276.08	Professional		$88.70	$141.02	$276.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $32.81 / $45.47 / $101.80	Professional	26	$32.81	$45.47	$101.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $55.05 / $80.84 / $179.61	Professional	TC	$55.05	$80.84	$179.61
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $318.58 / $318.58 / $318.58	Professional		$318.58	$318.58	$318.58
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $121.99 / $121.99 / $121.99	Professional	26	$121.99	$121.99	$121.99
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $196.59 / $196.59 / $196.59	Professional	TC	$196.59	$196.59	$196.59
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $94.57 / $115.04 / $139.69	Professional		$94.57	$115.04	$139.69
United Facility/Professional Professional Modifier Low / Median / High Price $75.03 / $98.82 / $274.54	Professional		$75.03	$98.82	$274.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.46 / $38.25 / $106.57	Professional	26	$26.46	$38.25	$106.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.01 / $60.68 / $182.76	Professional	TC	$47.01	$60.68	$182.76