Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.73 / $62.80 / $341.88	Facility	26	$56.73	$62.80	$341.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.51 / $105.15 / $372.00	Professional		$81.51	$105.15	$372.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.96 / $65.87 / $247.00	Professional	26	$53.96	$65.87	$247.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.10 / $32.32 / $72.16	Professional	TC	$25.10	$32.32	$72.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.07 / $103.86 / $501.05	Professional		$84.07	$103.86	$501.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.08 / $112.08 / $112.08	Professional	26	$112.08	$112.08	$112.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.38 / $114.36 / $248.04	Professional		$87.38	$114.36	$248.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.91 / $79.54 / $154.72	Professional	26	$60.91	$79.54	$154.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.12 / $38.53 / $87.81	Professional	TC	$26.12	$38.53	$87.81
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $59.55 / $84.58 / $189.25	Professional		$59.55	$84.58	$189.25
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.25 / $56.07 / $125.04	Professional	26	$39.25	$56.07	$125.04
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $20.20 / $28.45 / $72.34	Professional	TC	$20.20	$28.45	$72.34
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.81 / $62.81 / $62.81	Facility	26	$62.81	$62.81	$62.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $88.39 / $121.79 / $326.74	Professional		$88.39	$121.79	$326.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.22 / $78.28 / $191.95	Professional	26	$60.22	$78.28	$191.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.71 / $44.06 / $125.50	Professional	TC	$27.71	$44.06	$125.50
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $75.90 / $118.76 / $160.33	Professional		$75.90	$118.76	$160.33
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.85 / $61.70 / $83.30	Professional	26	$50.85	$61.70	$83.30
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.05 / $57.06 / $77.03	Professional	TC	$25.05	$57.06	$77.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $89.02 / $110.53 / $235.89	Professional		$89.02	$110.53	$235.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.41 / $61.70 / $134.51	Professional	26	$50.41	$61.70	$134.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.90 / $57.06 / $124.39	Professional	TC	$41.90	$57.06	$124.39
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $129.41 / $215.45 / $270.89	Facility	26	$129.41	$215.45	$270.89
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $746.58 / $746.58 / $795.23	Professional		$746.58	$746.58	$795.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $352.29 / $352.29 / $440.48	Professional	26	$352.29	$352.29	$440.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $288.04 / $288.04 / $354.75	Professional	TC	$288.04	$288.04	$354.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $57.21 / $135.62	Professional		$32.34	$57.21	$135.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $62.81 / $62.81 / $62.81	Facility	26	$62.81	$62.81	$62.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $91.04 / $132.55 / $267.75	Professional		$91.04	$132.55	$267.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.30 / $76.23 / $156.53	Professional	26	$60.30	$76.23	$156.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.71 / $42.86 / $97.55	Professional	TC	$27.71	$42.86	$97.55
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $303.45 / $303.45 / $303.45	Professional		$303.45	$303.45	$303.45
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $191.00 / $191.00 / $191.00	Professional	26	$191.00	$191.00	$191.00
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $112.44 / $112.44 / $112.44	Professional	TC	$112.44	$112.44	$112.44
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $96.03 / $108.04 / $132.04	Professional		$96.03	$108.04	$132.04
United Facility/Professional Professional Modifier Low / Median / High Price $69.30 / $94.30 / $241.79	Professional		$69.30	$94.30	$241.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.64 / $62.40 / $146.72	Professional	26	$45.64	$62.40	$146.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.56 / $32.90 / $84.12	Professional	TC	$22.56	$32.90	$84.12