Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.02 / $22.01 / $143.57	Facility	26	$18.02	$22.01	$143.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.10 / $98.16 / $340.90	Professional		$56.10	$98.16	$340.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.92 / $31.23 / $98.32	Professional	26	$16.92	$31.23	$98.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.02 / $64.31 / $139.03	Professional	TC	$25.02	$64.31	$139.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.53 / $46.74 / $108.55	Professional		$32.53	$46.74	$108.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.63 / $23.34 / $52.90	Professional	26	$17.63	$23.34	$52.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.73 / $30.73 / $41.18	Professional	TC	$30.73	$30.73	$41.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.47 / $97.50 / $180.30	Professional		$59.47	$97.50	$180.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.29 / $25.95 / $55.67	Professional	26	$19.29	$25.95	$55.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.70 / $71.42 / $124.06	Professional	TC	$32.70	$71.42	$124.06
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $77.53 / $100.00 / $228.08	Professional		$77.53	$100.00	$228.08
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.57 / $21.60 / $57.62	Professional	26	$15.57	$21.60	$57.62
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $59.96 / $79.44 / $176.40	Professional	TC	$59.96	$79.44	$176.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.65 / $26.65 / $26.65	Facility	26	$26.65	$26.65	$26.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.39 / $92.13 / $189.83	Professional		$42.39	$92.13	$189.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.34 / $27.04 / $66.02	Professional	26	$19.34	$27.04	$66.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.18 / $53.10 / $126.84	Professional	TC	$21.18	$53.10	$126.84
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $42.17 / $62.55 / $84.44	Professional		$42.17	$62.55	$84.44
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.09 / $26.15 / $35.29	Professional	26	$21.09	$26.15	$35.29
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.09 / $36.40 / $49.14	Professional	TC	$21.09	$36.40	$49.14
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $61.91 / $61.91 / $61.91	Professional		$61.91	$61.91	$61.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.91 / $65.98 / $130.00	Professional		$48.91	$65.98	$130.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.20 / $32.60 / $54.86	Professional	26	$23.20	$32.60	$54.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.45 / $42.74 / $71.48	Professional	TC	$29.45	$42.74	$71.48
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $55.69 / $115.00 / $115.19	Facility	26	$55.69	$115.00	$115.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $575.66 / $592.92 / $592.92	Professional		$575.66	$592.92	$592.92
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $232.81 / $232.81 / $232.81	Professional	26	$232.81	$232.81	$232.81
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $385.57 / $398.91 / $409.84	Professional	TC	$385.57	$398.91	$409.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.99 / $32.34 / $32.34	Professional		$27.99	$32.34	$32.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.65 / $26.65 / $26.65	Facility	26	$26.65	$26.65	$26.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.26 / $94.52 / $148.58	Professional		$44.26	$94.52	$148.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.34 / $26.20 / $62.74	Professional	26	$19.34	$26.20	$62.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $21.18 / $56.31 / $124.84	Professional	TC	$21.18	$56.31	$124.84
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $160.51 / $160.51 / $160.51	Professional		$160.51	$160.51	$160.51
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $80.53 / $80.53 / $80.53	Professional	26	$80.53	$80.53	$80.53
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $79.98 / $79.98 / $79.98	Professional	TC	$79.98	$79.98	$79.98
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $50.58 / $69.54 / $102.93	Professional		$50.58	$69.54	$102.93
United Facility/Professional Professional Modifier Low / Median / High Price $48.34 / $68.72 / $154.93	Professional		$48.34	$68.72	$154.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.94 / $25.26 / $63.04	Professional	26	$14.94	$25.26	$63.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.64 / $38.86 / $93.00	Professional	TC	$23.64	$38.86	$93.00