Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.82 / $36.11 / $184.01	Facility	26	$27.82	$36.11	$184.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.06 / $161.71 / $608.96	Professional		$107.06	$161.71	$608.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.82 / $48.56 / $158.00	Professional	26	$27.82	$48.56	$158.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.76 / $96.17 / $266.01	Professional	TC	$71.76	$96.17	$266.01
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.59 / $105.20 / $203.89	Professional		$70.59	$105.20	$203.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.32 / $32.36 / $68.12	Professional	26	$22.32	$32.36	$68.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $48.28 / $94.29 / $144.72	Professional	TC	$48.28	$94.29	$144.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.32 / $140.22 / $288.20	Professional		$102.32	$140.22	$288.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.17 / $40.95 / $80.73	Professional	26	$28.17	$40.95	$80.73
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.84 / $98.20 / $210.32	Professional	TC	$70.84	$98.20	$210.32
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $92.58 / $120.16 / $297.75	Professional		$92.58	$120.16	$297.75
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.97 / $31.33 / $86.91	Professional	26	$24.97	$31.33	$86.91
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $67.62 / $91.25 / $218.81	Professional	TC	$67.62	$91.25	$218.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.36 / $34.36 / $34.36	Facility	26	$34.36	$34.36	$34.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.16 / $135.47 / $289.68	Professional		$75.16	$135.47	$289.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.70 / $39.96 / $85.98	Professional	26	$26.70	$39.96	$85.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.06 / $95.16 / $216.47	Professional	TC	$43.06	$95.16	$216.47
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $59.78 / $128.81 / $173.89	Professional		$59.78	$128.81	$173.89
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.90 / $33.51 / $45.24	Professional	26	$26.90	$33.51	$45.24
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.88 / $95.30 / $128.66	Professional	TC	$32.88	$95.30	$128.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $99.27 / $130.21 / $228.25	Professional		$99.27	$130.21	$228.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.67 / $41.81 / $70.36	Professional	26	$29.67	$41.81	$70.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $76.23 / $111.85 / $187.01	Professional	TC	$76.23	$111.85	$187.01
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.90 / $136.22 / $147.82	Facility	26	$85.90	$136.22	$147.82
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $654.87 / $654.87 / $836.03	Professional		$654.87	$654.87	$836.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $217.94 / $217.94 / $242.48	Professional	26	$217.94	$217.94	$242.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $461.63 / $461.63 / $593.54	Professional	TC	$461.63	$461.63	$593.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $78.23	Professional		$32.34	$32.34	$78.23
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $34.36 / $34.36 / $34.36	Facility	26	$34.36	$34.36	$34.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $82.57 / $140.19 / $278.24	Professional		$82.57	$140.19	$278.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.81 / $38.36 / $84.48	Professional	26	$26.81	$38.36	$84.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.87 / $89.36 / $202.37	Professional	TC	$42.87	$89.36	$202.37
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $350.40 / $350.40 / $350.40	Professional		$350.40	$350.40	$350.40
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $103.31 / $103.31 / $103.31	Professional	26	$103.31	$103.31	$103.31
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $247.08 / $247.08 / $247.08	Professional	TC	$247.08	$247.08	$247.08
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $89.67 / $131.41 / $159.57	Professional		$89.67	$131.41	$159.57
United Facility/Professional Professional Modifier Low / Median / High Price $83.91 / $106.83 / $322.52	Professional		$83.91	$106.83	$322.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.02 / $32.47 / $84.47	Professional	26	$23.02	$32.47	$84.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.67 / $74.34 / $215.67	Professional	TC	$52.67	$74.34	$215.67