Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.69 / $28.53 / $171.76	Facility	26	$27.69	$28.53	$171.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.26 / $118.70 / $308.64	Professional		$98.26	$118.70	$308.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.63 / $29.28 / $110.84	Professional	26	$25.63	$29.28	$110.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.18 / $78.81 / $147.63	Professional	TC	$71.18	$78.81	$147.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.14 / $99.22 / $118.71	Professional		$66.14	$99.22	$118.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.02 / $29.31 / $64.44	Professional	26	$21.02	$29.31	$64.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.12 / $204.62 / $393.67	Professional		$122.12	$204.62	$393.67
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.01 / $53.38 / $102.70	Professional	26	$33.01	$53.38	$102.70
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $151.22 / $290.97	Professional	TC	$87.95	$151.22	$290.97
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $130.63 / $313.48	Professional		$100.00	$130.63	$313.48
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.91 / $34.32 / $98.12	Professional	26	$27.91	$34.32	$98.12
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $76.12 / $100.00 / $233.09	Professional	TC	$76.12	$100.00	$233.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Facility	26	$32.36	$32.36	$32.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.97 / $143.15 / $316.05	Professional		$94.97	$143.15	$316.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.90 / $37.92 / $82.15	Professional	26	$25.90	$37.92	$82.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.66 / $106.35 / $236.21	Professional	TC	$72.66	$106.35	$236.21
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $97.60 / $137.61 / $185.77	Professional		$97.60	$137.61	$185.77
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.54 / $31.75 / $42.86	Professional	26	$18.54	$31.75	$42.86
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.06 / $105.86 / $142.91	Professional	TC	$79.06	$105.86	$142.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $106.21 / $138.29 / $242.53	Professional		$106.21	$138.29	$242.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.03 / $39.57 / $66.59	Professional	26	$28.03	$39.57	$66.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $86.37 / $124.23 / $207.71	Professional	TC	$86.37	$124.23	$207.71
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $67.03 / $128.65 / $139.84	Facility	26	$67.03	$128.65	$139.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $674.54 / $674.54 / $888.15	Professional		$674.54	$674.54	$888.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $180.38 / $180.38 / $229.58	Professional	26	$180.38	$180.38	$229.58
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $494.15 / $494.15 / $658.65	Professional	TC	$494.15	$494.15	$658.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $72.81	Professional		$32.34	$32.34	$72.81
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Facility	26	$32.36	$32.36	$32.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $98.67 / $158.18 / $307.11	Professional		$98.67	$158.18	$307.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.93 / $37.40 / $80.37	Professional	26	$25.93	$37.40	$80.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $72.66 / $105.06 / $233.90	Professional	TC	$72.66	$105.06	$233.90
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $360.27 / $360.27 / $360.27	Professional		$360.27	$360.27	$360.27
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $96.35 / $96.35 / $96.35	Professional	26	$96.35	$96.35	$96.35
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $263.91 / $263.91 / $263.91	Professional	TC	$263.91	$263.91	$263.91
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $111.29 / $136.63 / $165.92	Professional		$111.29	$136.63	$165.92
United Facility/Professional Professional Modifier Low / Median / High Price $84.07 / $109.71 / $311.67	Professional		$84.07	$109.71	$311.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.51 / $30.43 / $95.21	Professional	26	$23.51	$30.43	$95.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.56 / $79.39 / $229.33	Professional	TC	$60.56	$79.39	$229.33