Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.87 / $28.84 / $149.44	Facility	26	$25.87	$28.84	$149.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $99.12 / $164.28 / $505.89	Professional		$99.12	$164.28	$505.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $37.89 / $126.00	Professional	26	$25.12	$37.89	$126.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.38 / $86.58 / $219.08	Professional	TC	$76.38	$86.58	$219.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.52 / $175.24 / $521.87	Professional		$109.52	$175.24	$521.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.73 / $39.64 / $135.13	Professional	26	$22.73	$39.64	$135.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $133.51 / $133.51 / $133.51	Professional	TC	$133.51	$133.51	$133.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.24 / $191.47 / $346.18	Professional		$123.24	$191.47	$346.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.31 / $54.86 / $98.39	Professional	26	$30.31	$54.86	$98.39
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.59 / $136.16 / $249.83	Professional	TC	$93.59	$136.16	$249.83
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $135.80 / $329.70	Professional		$100.00	$135.80	$329.70
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $26.46 / $34.00 / $90.13	Professional	26	$26.46	$34.00	$90.13
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $104.10 / $251.21	Professional	TC	$79.43	$104.10	$251.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.20 / $28.20 / $28.20	Facility	26	$28.20	$28.20	$28.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.43 / $150.44 / $319.33	Professional		$108.43	$150.44	$319.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.78 / $35.95 / $75.53	Professional	26	$26.78	$35.95	$75.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.33 / $119.17 / $266.02	Professional	TC	$82.33	$119.17	$266.02
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $75.05 / $127.09 / $171.57	Professional		$75.05	$127.09	$171.57
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.20 / $30.02 / $36.72	Professional	26	$27.20	$30.02	$36.72
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.03 / $99.89 / $134.85	Professional	TC	$45.03	$99.89	$134.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $98.01 / $127.58 / $246.79	Professional		$98.01	$127.58	$246.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.11 / $33.94 / $57.13	Professional	26	$24.11	$33.94	$57.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.91 / $117.23 / $196.01	Professional	TC	$79.91	$117.23	$196.01
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.98 / $119.99 / $136.00	Facility	26	$57.98	$119.99	$136.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $698.76 / $698.76 / $817.73	Professional		$698.76	$698.76	$817.73
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $226.20 / $279.51 / $279.51	Professional	26	$226.20	$279.51	$279.51
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $479.00 / $479.00 / $621.90	Professional	TC	$479.00	$479.00	$621.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $99.71	Professional		$32.34	$32.34	$99.71
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $28.20 / $28.20 / $28.20	Facility	26	$28.20	$28.20	$28.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $108.96 / $163.18 / $299.69	Professional		$108.96	$163.18	$299.69
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.89 / $35.21 / $69.37	Professional	26	$26.89	$35.21	$69.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $82.33 / $119.08 / $241.55	Professional	TC	$82.33	$119.08	$241.55
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $331.07 / $331.07 / $331.07	Professional		$331.07	$331.07	$331.07
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $83.98 / $83.98 / $83.98	Professional	26	$83.98	$83.98	$83.98
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $247.08 / $247.08 / $247.08	Professional	TC	$247.08	$247.08	$247.08
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $102.78 / $141.33 / $204.79	Professional		$102.78	$141.33	$204.79
United Facility/Professional Professional Modifier Low / Median / High Price $80.91 / $121.89 / $283.43	Professional		$80.91	$121.89	$283.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.44 / $29.34 / $68.63	Professional	26	$20.44	$29.34	$68.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.74 / $89.20 / $225.12	Professional	TC	$59.74	$89.20	$225.12