Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.68 / $69.54 / $371.26	Facility	26	$62.68	$69.54	$371.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.76 / $113.54 / $417.93	Professional		$90.76	$113.54	$417.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.57 / $69.73 / $281.00	Professional	26	$59.57	$69.73	$281.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.48 / $36.67 / $84.04	Professional	TC	$28.48	$36.67	$84.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.13 / $123.87 / $149.32	Professional		$112.13	$123.87	$149.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.41 / $67.30 / $135.66	Professional	26	$58.41	$67.30	$135.66
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.81 / $128.34 / $269.24	Professional		$96.81	$128.34	$269.24
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.11 / $88.91 / $177.28	Professional	26	$67.11	$88.91	$177.28
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.97 / $41.91 / $97.97	Professional	TC	$28.97	$41.91	$97.97
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $69.70 / $99.02 / $221.28	Professional		$69.70	$99.02	$221.28
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.68 / $66.68 / $147.15	Professional	26	$46.68	$66.68	$147.15
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $22.92 / $32.33 / $82.27	Professional	TC	$22.92	$32.33	$82.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.20 / $68.20 / $68.20	Facility	26	$68.20	$68.20	$68.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.51 / $136.22 / $361.99	Professional		$98.51	$136.22	$361.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.01 / $88.98 / $210.31	Professional	26	$66.01	$88.98	$210.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.46 / $48.53 / $134.04	Professional	TC	$31.46	$48.53	$134.04
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $88.93 / $128.25 / $173.14	Professional		$88.93	$128.25	$173.14
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.47 / $72.56 / $90.53	Professional	26	$60.47	$72.56	$90.53
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.46 / $61.19 / $82.61	Professional	TC	$28.46	$61.19	$82.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $96.11 / $119.37 / $254.77	Professional		$96.11	$119.37	$254.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.77 / $67.06 / $146.19	Professional	26	$54.77	$67.06	$146.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.92 / $61.19 / $133.38	Professional	TC	$44.92	$61.19	$133.38
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $140.60 / $234.08 / $294.26	Facility	26	$140.60	$234.08	$294.26
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $865.60 / $865.60 / $865.60	Professional		$865.60	$865.60	$865.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $382.35 / $382.35 / $477.60	Professional	26	$382.35	$382.35	$477.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $307.58 / $307.58 / $380.25	Professional	TC	$307.58	$307.58	$380.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $61.23 / $146.33	Professional		$32.34	$61.23	$146.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $68.20 / $68.20 / $68.20	Facility	26	$68.20	$68.20	$68.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $103.08 / $143.66 / $288.42	Professional		$103.08	$143.66	$288.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.44 / $86.12 / $170.63	Professional	26	$66.44	$86.12	$170.63
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.64 / $46.97 / $112.20	Professional	TC	$31.64	$46.97	$112.20
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $328.19 / $328.19 / $328.19	Professional		$328.19	$328.19	$328.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $207.33 / $207.33 / $207.33	Professional	26	$207.33	$207.33	$207.33
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $120.86 / $120.86 / $120.86	Professional	TC	$120.86	$120.86	$120.86
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $103.71 / $116.68 / $151.18	Professional		$103.71	$116.68	$151.18
United Facility/Professional Professional Modifier Low / Median / High Price $75.59 / $104.53 / $251.22	Professional		$75.59	$104.53	$251.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.84 / $69.76 / $151.69	Professional	26	$49.84	$69.76	$151.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $35.00 / $90.66	Professional	TC	$24.44	$35.00	$90.66