Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $120.23 / $338.84	Facility	26	$61.66	$120.23	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $117.49 / $407.38	Professional		$93.33	$117.49	$407.38
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $218.78 / $218.78 / $218.78	Professional	25	$218.78	$218.78	$218.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $281.84	Professional	26	$57.54	$77.62	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $44.67 / $89.13	Professional	TC	$30.20	$44.67	$89.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $123.03 / $251.19	Professional		$100.00	$123.03	$251.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $67.61 / $123.03	Professional	26	$56.23	$67.61	$123.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $147.91 / $288.40	Professional		$102.33	$147.91	$288.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $102.33 / $190.55	Professional	26	$69.18	$102.33	$190.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $47.86 / $102.33	Professional	TC	$31.62	$47.86	$102.33
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $114.82 / $263.03	Professional		$85.11	$114.82	$263.03
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $79.43 / $169.82	Professional	26	$57.54	$79.43	$169.82
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $37.15 / $93.33	Professional	TC	$27.54	$37.15	$93.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $97.72	Facility	26	$14.45	$67.61	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $134.90 / $309.03	Professional		$100.00	$134.90	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $87.10 / $190.55	Professional	26	$66.07	$87.10	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $48.98 / $123.03	Professional	TC	$31.62	$48.98	$123.03
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $131.83 / $177.83	Professional		$89.13	$131.83	$177.83
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $72.44 / $93.33	Professional	26	$60.26	$72.44	$93.33
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $63.10 / $85.11	Professional	TC	$28.18	$63.10	$85.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $120.23 / $245.47	Professional		$100.00	$120.23	$245.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $63.10 / $112.20	Professional	26	$56.23	$63.10	$112.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $57.54 / $97.72	Professional	TC	$46.77	$57.54	$97.72
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $380.19 / $380.19 / $380.19	Facility	26	$380.19	$380.19	$380.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $870.96 / $870.96	Professional		$870.96	$870.96	$870.96
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $380.19 / $478.63 / $478.63	Professional	26	$380.19	$478.63	$478.63
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $380.19 / $380.19	Professional	TC	$309.03	$380.19	$380.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $85.11 / $147.91	Professional		$61.66	$85.11	$147.91
Providence Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $138.04 / $288.40	Professional		$104.71	$138.04	$288.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $87.10 / $165.96	Professional	26	$66.07	$87.10	$165.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $47.86 / $100.00	Professional	TC	$32.36	$47.86	$100.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $331.13 / $331.13	Professional		$331.13	$331.13	$331.13
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Professional	26	$208.93	$208.93	$208.93
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $120.23 / $120.23	Professional	TC	$120.23	$120.23	$120.23
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $120.23 / $151.36	Professional		$89.13	$120.23	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $107.15 / $229.09	Professional		$75.86	$107.15	$229.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $72.44 / $144.54	Professional	26	$50.12	$72.44	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $36.31 / $87.10	Professional	TC	$25.12	$36.31	$87.10