Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.29 / $32.08 / $183.81	Facility	26	$26.29	$32.08	$183.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.60 / $115.64 / $488.83	Professional		$58.60	$115.64	$488.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $33.97 / $141.16	Professional	26	$24.78	$33.97	$141.16
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $102.86 / $102.86 / $666.36	Professional	50	$102.86	$102.86	$666.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.29 / $89.34 / $189.89	Professional	TC	$18.29	$89.34	$189.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.00 / $48.07 / $78.04	Professional		$41.00	$48.07	$78.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.74 / $67.06 / $74.05	Professional	26	$31.74	$67.06	$74.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.07 / $144.35 / $279.25	Professional		$92.07	$144.35	$279.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.64 / $37.15 / $74.95	Professional	26	$24.64	$37.15	$74.95
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $77.70 / $95.55 / $191.28	Professional	50	$77.70	$95.55	$191.28
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.50 / $109.00 / $201.81	Professional	TC	$54.50	$109.00	$201.81
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $153.32 / $351.68	Professional		$100.00	$153.32	$351.68
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.49 / $35.49 / $100.00	Professional	26	$28.49	$35.49	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $80.17 / $117.27 / $267.85	Professional	TC	$80.17	$117.27	$267.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.32 / $49.32 / $49.32	Facility	26	$49.32	$49.32	$49.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.77 / $138.79 / $282.52	Professional		$70.77	$138.79	$282.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.62 / $39.89 / $88.36	Professional	26	$27.62	$39.89	$88.36
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $131.31 / $131.31 / $131.31	Professional	50	$131.31	$131.31	$131.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.64 / $99.12 / $207.84	Professional	TC	$19.64	$99.12	$207.84
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $53.29 / $62.23 / $84.01	Professional		$53.29	$62.23	$84.01
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.32 / $47.86 / $64.61	Professional	26	$13.32	$47.86	$64.61
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.37 / $19.39 / $47.96	Professional	TC	$14.37	$19.39	$47.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.30 / $66.76 / $126.66	Professional		$50.30	$66.76	$126.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.26 / $59.63 / $100.35	Professional	26	$42.26	$59.63	$100.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $11.77 / $17.23 / $28.29	Professional	TC	$11.77	$17.23	$28.29
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $101.38 / $193.75 / $210.71	Facility	26	$101.38	$193.75	$210.71
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $558.63 / $575.39 / $575.39	Professional		$558.63	$575.39	$575.39
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $253.44 / $260.82 / $344.78	Professional	26	$253.44	$260.82	$344.78
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $430.88 / $443.81 / $443.81	Professional	TC	$430.88	$443.81	$443.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $76.54	Professional		$32.34	$32.34	$76.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $49.32 / $49.32 / $49.32	Facility	26	$49.32	$49.32	$49.32
Providence Facility/Professional Professional Modifier Low / Median / High Price $70.31 / $139.51 / $236.01	Professional		$70.31	$139.51	$236.01
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.62 / $39.15 / $85.96	Professional	26	$27.62	$39.15	$85.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.22 / $101.33 / $211.47	Professional	TC	$31.22	$101.33	$211.47
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $258.44 / $258.44 / $258.44	Professional		$258.44	$258.44	$258.44
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $102.71 / $102.71 / $102.71	Professional	26	$102.71	$102.71	$102.71
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $155.72 / $155.72 / $155.72	Professional	TC	$155.72	$155.72	$155.72
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $50.30 / $69.16 / $90.59	Professional		$50.30	$69.16	$90.59
United Facility/Professional Professional Modifier Low / Median / High Price $73.91 / $96.34 / $231.75	Professional		$73.91	$96.34	$231.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.15 / $32.11 / $90.48	Professional	26	$24.15	$32.11	$90.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.23 / $70.23 / $149.80	Professional	TC	$42.23	$70.23	$149.80