Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.93 / $12.70 / $64.01	Facility	26	$9.93	$12.70	$64.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.86 / $97.90 / $252.78	Professional		$40.86	$97.90	$252.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $10.92 / $43.89	Professional	26	$9.11	$10.92	$43.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.37 / $87.98 / $172.43	Professional	TC	$27.37	$87.98	$172.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.40 / $44.26 / $87.56	Professional		$35.40	$44.26	$87.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.94 / $12.20 / $22.42	Professional	26	$6.94	$12.20	$22.42
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.99 / $39.39 / $62.28	Professional	TC	$26.99	$39.39	$62.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.68 / $122.61 / $214.06	Professional		$45.68	$122.61	$214.06
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.48 / $14.94 / $28.42	Professional	26	$10.48	$14.94	$28.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.06 / $109.33 / $187.92	Professional	TC	$34.06	$109.33	$187.92
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $40.26 / $52.68 / $207.85	Professional		$40.26	$52.68	$207.85
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.28 / $11.94 / $27.51	Professional	26	$9.28	$11.94	$27.51
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $31.54 / $40.54 / $180.03	Professional	TC	$31.54	$40.54	$180.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.80 / $10.80 / $10.80	Facility	26	$10.80	$10.80	$10.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.40 / $77.67 / $163.34	Professional		$35.40	$77.67	$163.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.53 / $12.67 / $27.20	Professional	26	$8.53	$12.67	$27.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.05 / $65.91 / $146.31	Professional	TC	$28.05	$65.91	$146.31
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $34.27 / $51.39 / $69.38	Professional		$34.27	$51.39	$69.38
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.40 / $14.04	Professional	26	$8.22	$10.40	$14.04
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.05 / $40.99 / $55.34	Professional	TC	$26.05	$40.99	$55.34
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $87.06 / $87.06 / $87.06	Professional		$87.06	$87.06	$87.06
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $20.35 / $20.35 / $20.35	Professional	26	$20.35	$20.35	$20.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.65 / $50.90 / $96.80	Professional		$38.65	$50.90	$96.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.22 / $12.48 / $19.55	Professional	26	$9.22	$12.48	$19.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $47.48 / $76.95	Professional	TC	$32.79	$47.48	$76.95
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $53.19 / $70.00 / $80.00	Facility	26	$53.19	$70.00	$80.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $528.05 / $539.95 / $554.75	Professional		$528.05	$539.95	$554.75
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.55 / $97.55 / $97.55	Professional	26	$97.55	$97.55	$97.55
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $477.35 / $492.53 / $506.03	Professional	TC	$477.35	$492.53	$506.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.65 / $32.34 / $32.34	Professional		$31.65	$32.34	$32.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.80 / $10.80 / $10.80	Facility	26	$10.80	$10.80	$10.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $37.72 / $81.25 / $148.49	Professional		$37.72	$81.25	$148.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.53 / $12.42 / $26.14	Professional	26	$8.53	$12.42	$26.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.05 / $72.97 / $146.28	Professional	TC	$28.05	$72.97	$146.28
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $131.32 / $131.32 / $131.32	Professional		$131.32	$131.32	$131.32
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $32.10 / $32.10 / $32.10	Professional	26	$32.10	$32.10	$32.10
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $99.22 / $99.22 / $99.22	Professional	TC	$99.22	$99.22	$99.22
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $41.56 / $47.97 / $58.25	Professional		$41.56	$47.97	$58.25
United Facility/Professional Professional Modifier Low / Median / High Price $29.24 / $55.68 / $133.10	Professional		$29.24	$55.68	$133.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.38 / $10.57 / $23.85	Professional	26	$7.38	$10.57	$23.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.86 / $40.02 / $111.78	Professional	TC	$21.86	$40.02	$111.78