Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.25 / $46.80 / $252.19	Facility	26	$42.25	$46.80	$252.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.72 / $80.20 / $312.00	Professional		$63.72	$80.20	$312.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.17 / $47.02 / $193.63	Professional	26	$40.17	$47.02	$193.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.73 / $27.97 / $65.80	Professional	TC	$21.73	$27.97	$65.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $68.73 / $68.73 / $85.93	Professional		$68.73	$68.73	$85.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $76.89 / $76.89 / $76.89	Professional	26	$76.89	$76.89	$76.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.81 / $92.16 / $195.09	Professional		$67.81	$92.16	$195.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.93 / $59.72 / $119.45	Professional	26	$44.93	$59.72	$119.45
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.68 / $32.60 / $78.43	Professional	TC	$22.68	$32.60	$78.43
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $71.45 / $100.29 / $219.34	Professional		$71.45	$100.29	$219.34
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.42 / $65.91 / $133.52	Professional	26	$46.42	$65.91	$133.52
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.96 / $35.49 / $86.83	Professional	TC	$24.96	$35.49	$86.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.26 / $46.26 / $46.26	Facility	26	$46.26	$46.26	$46.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.27 / $98.86 / $258.06	Professional		$69.27	$98.86	$258.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.77 / $60.07 / $143.38	Professional	26	$44.77	$60.07	$143.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.10 / $40.34 / $115.06	Professional	TC	$24.10	$40.34	$115.06
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $62.35 / $97.50 / $131.63	Professional		$62.35	$97.50	$131.63
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.53 / $48.64 / $61.41	Professional	26	$40.53	$48.64	$61.41
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.82 / $52.01 / $70.20	Professional	TC	$21.82	$52.01	$70.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.59 / $90.37 / $192.00	Professional		$72.59	$90.37	$192.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.18 / $45.49 / $99.17	Professional	26	$37.18	$45.49	$99.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.19 / $52.01 / $113.38	Professional	TC	$38.19	$52.01	$113.38
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $95.51 / $159.01 / $199.79	Facility	26	$95.51	$159.01	$199.79
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $622.15 / $622.15 / $648.67	Professional		$622.15	$622.15	$648.67
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $262.07 / $262.07 / $324.98	Professional	26	$262.07	$262.07	$324.98
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $264.17 / $264.17 / $323.63	Professional	TC	$264.17	$264.17	$323.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $52.31 / $110.06	Professional		$32.34	$52.31	$110.06
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $46.26 / $46.26 / $46.26	Facility	26	$46.26	$46.26	$46.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $73.66 / $107.06 / $220.13	Professional		$73.66	$107.06	$220.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.77 / $58.25 / $115.46	Professional	26	$44.77	$58.25	$115.46
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.18 / $37.79 / $85.60	Professional	TC	$24.18	$37.79	$85.60
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $243.56 / $243.56 / $243.56	Professional		$243.56	$243.56	$243.56
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $140.72 / $140.72 / $140.72	Professional	26	$140.72	$140.72	$140.72
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $102.82 / $102.82 / $102.82	Professional	TC	$102.82	$102.82	$102.82
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $78.84 / $88.70 / $108.42	Professional		$78.84	$88.70	$108.42
United Facility/Professional Professional Modifier Low / Median / High Price $54.87 / $76.90 / $184.17	Professional		$54.87	$76.90	$184.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.61 / $46.99 / $104.16	Professional	26	$33.61	$46.99	$104.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.82 / $29.76 / $78.42	Professional	TC	$19.82	$29.76	$78.42