Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.58 / $25.74 / $161.50	Facility	26	$24.58	$25.74	$161.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.09 / $110.69 / $474.00	Professional		$88.09	$110.69	$474.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.17 / $27.03 / $107.58	Professional	26	$23.17	$27.03	$107.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.52 / $78.43 / $218.03	Professional	TC	$63.52	$78.43	$218.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $73.78 / $73.78 / $93.92	Professional		$73.78	$73.78	$93.92
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.53 / $47.79 / $49.17	Professional	26	$21.53	$47.79	$49.17
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $151.69 / $151.69 / $151.69	Professional	TC	$151.69	$151.69	$151.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.12 / $120.44 / $232.43	Professional		$87.12	$120.44	$232.43
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.00 / $35.10 / $68.41	Professional	26	$27.00	$35.10	$68.41
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $59.35 / $85.66 / $168.34	Professional	TC	$59.35	$85.66	$168.34
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $84.49 / $105.57 / $261.77	Professional		$84.49	$105.57	$261.77
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.81 / $31.53 / $72.56	Professional	26	$24.81	$31.53	$72.56
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $61.48 / $78.04 / $194.22	Professional	TC	$61.48	$78.04	$194.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.07 / $30.07 / $30.07	Facility	26	$30.07	$30.07	$30.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.50 / $123.41 / $268.52	Professional		$81.50	$123.41	$268.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.25 / $32.96 / $72.09	Professional	26	$23.25	$32.96	$72.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.25 / $91.35 / $200.87	Professional	TC	$58.25	$91.35	$200.87
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $78.50 / $128.86 / $173.96	Professional		$78.50	$128.86	$173.96
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.55 / $28.97 / $39.11	Professional	26	$23.55	$28.97	$39.11
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $99.89 / $134.85	Professional	TC	$54.95	$99.89	$134.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.13 / $127.87 / $217.00	Professional		$97.13	$127.87	$217.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.65 / $34.76 / $54.46	Professional	26	$25.65	$34.76	$54.46
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.91 / $115.62 / $187.45	Professional	TC	$79.91	$115.62	$187.45
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.90 / $127.92 / $127.92	Facility	26	$85.90	$127.92	$127.92
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $642.13 / $642.13 / $832.58	Professional		$642.13	$642.13	$832.58
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $167.46 / $167.46 / $210.75	Professional	26	$167.46	$167.46	$210.75
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $474.67 / $474.67 / $621.90	Professional	TC	$474.67	$474.67	$621.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $67.73	Professional		$32.34	$32.34	$67.73
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $30.07 / $30.07 / $30.07	Facility	26	$30.07	$30.07	$30.07
Providence Facility/Professional Professional Modifier Low / Median / High Price $84.78 / $138.26 / $267.75	Professional		$84.78	$138.26	$267.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.25 / $32.42 / $71.64	Professional	26	$23.25	$32.42	$71.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $58.77 / $91.35 / $194.79	Professional	TC	$58.77	$91.35	$194.79
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $317.19 / $317.19 / $317.19	Professional		$317.19	$317.19	$317.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $90.54 / $90.54 / $90.54	Professional	26	$90.54	$90.54	$90.54
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $226.65 / $226.65 / $226.65	Professional	TC	$226.65	$226.65	$226.65
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $102.05 / $117.23 / $143.29	Professional		$102.05	$117.23	$143.29
United Facility/Professional Professional Modifier Low / Median / High Price $73.84 / $105.86 / $239.37	Professional		$73.84	$105.86	$239.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.74 / $28.51 / $74.09	Professional	26	$20.74	$28.51	$74.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.10 / $77.73 / $176.17	Professional	TC	$53.10	$77.73	$176.17