Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.22 / $37.52 / $193.75	Facility	26	$31.22	$37.52	$193.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.07 / $147.72 / $637.79	Professional		$101.07	$147.72	$637.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $47.70 / $153.46	Professional	26	$29.75	$47.70	$153.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.15 / $102.17 / $431.00	Professional	TC	$79.15	$102.17	$431.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.13 / $111.21 / $231.50	Professional		$78.13	$111.21	$231.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.07 / $31.90 / $65.93	Professional	26	$24.07	$31.90	$65.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $70.95 / $95.04 / $132.29	Professional	TC	$70.95	$95.04	$132.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.59 / $145.16 / $294.16	Professional		$114.59	$145.16	$294.16
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $45.90 / $92.74	Professional	26	$33.54	$45.90	$92.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.59 / $100.15 / $209.64	Professional	TC	$75.59	$100.15	$209.64
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $88.16 / $114.22 / $285.61	Professional		$88.16	$114.22	$285.61
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.35 / $32.65 / $91.19	Professional	26	$25.35	$32.65	$91.19
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $62.81 / $83.76 / $209.44	Professional	TC	$62.81	$83.76	$209.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.07 / $37.07 / $37.07	Facility	26	$37.07	$37.07	$37.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.15 / $144.65 / $320.58	Professional		$95.15	$144.65	$320.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.81 / $42.96 / $92.64	Professional	26	$28.81	$42.96	$92.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.86 / $102.75 / $225.63	Professional	TC	$65.86	$102.75	$225.63
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $67.65 / $135.16 / $182.47	Professional		$67.65	$135.16	$182.47
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.30 / $36.19 / $48.86	Professional	26	$20.30	$36.19	$48.86
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.36 / $98.97 / $133.61	Professional	TC	$47.36	$98.97	$133.61
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $199.35 / $224.26 / $301.12	Professional		$199.35	$224.26	$301.12
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $137.35 / $141.22 / $141.22	Professional	26	$137.35	$141.22	$141.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.21 / $137.27 / $239.65	Professional		$104.21	$137.27	$239.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.01 / $45.13 / $75.95	Professional	26	$32.01	$45.13	$75.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $80.06 / $116.15 / $194.21	Professional	TC	$80.06	$116.15	$194.21
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $98.17 / $159.51 / $171.00	Facility	26	$98.17	$159.51	$171.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $687.27 / $687.27 / $877.28	Professional		$687.27	$687.27	$877.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $254.27 / $254.27 / $261.08	Professional	26	$254.27	$254.27	$261.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $479.00 / $479.00 / $616.20	Professional	TC	$479.00	$479.00	$616.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $80.80	Professional		$32.34	$32.34	$80.80
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $37.07 / $37.07 / $37.07	Facility	26	$37.07	$37.07	$37.07
Providence Facility/Professional Professional Modifier Low / Median / High Price $100.41 / $159.57 / $312.52	Professional		$100.41	$159.57	$312.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.95 / $41.39 / $90.98	Professional	26	$28.95	$41.39	$90.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $65.73 / $102.11 / $225.38	Professional	TC	$65.73	$102.11	$225.38
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $365.78 / $365.78 / $365.78	Professional		$365.78	$365.78	$365.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $111.48 / $111.48 / $111.48	Professional	26	$111.48	$111.48	$111.48
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $254.30 / $254.30 / $254.30	Professional	TC	$254.30	$254.30	$254.30
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $101.48 / $135.86 / $164.97	Professional		$101.48	$135.86	$164.97
United Facility/Professional Professional Modifier Low / Median / High Price $85.54 / $112.69 / $329.46	Professional		$85.54	$112.69	$329.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.73 / $35.01 / $91.15	Professional	26	$24.73	$35.01	$91.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.81 / $76.51 / $215.15	Professional	TC	$60.81	$76.51	$215.15