Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.76 / $20.26 / $138.10	Facility	26	$18.76	$20.26	$138.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $129.51 / $190.40 / $502.90	Professional		$129.51	$190.40	$502.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.76 / $23.37 / $81.90	Professional	26	$18.76	$23.37	$81.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.86 / $169.58 / $425.80	Professional	TC	$103.86	$169.58	$425.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.42 / $138.53 / $138.53	Professional		$102.42	$138.53	$138.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.89 / $20.07 / $111.41	Professional	26	$16.89	$20.07	$111.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $139.63 / $189.57 / $383.82	Professional		$139.63	$189.57	$383.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.16 / $26.99 / $64.33	Professional	26	$19.16	$26.99	$64.33
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $113.23 / $162.83 / $324.33	Professional	TC	$113.23	$162.83	$324.33
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $135.88 / $225.03 / $517.75	Professional		$135.88	$225.03	$517.75
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.12 / $23.64 / $67.43	Professional	26	$19.12	$23.64	$67.43
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $121.01 / $200.63 / $466.20	Professional	TC	$121.01	$200.63	$466.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.08 / $201.03 / $397.13	Professional		$133.08	$201.03	$397.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.70 / $29.62 / $66.52	Professional	26	$20.70	$29.62	$66.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.48 / $173.76 / $333.72	Professional	TC	$112.48	$173.76	$333.72
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $76.23 / $116.04 / $217.82	Professional		$76.23	$116.04	$217.82
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.67 / $16.25 / $33.40	Professional	26	$10.67	$16.25	$33.40
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.56 / $99.79 / $184.42	Professional	TC	$65.56	$99.79	$184.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.96 / $161.35 / $304.77	Professional		$123.96	$161.35	$304.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.26 / $30.93 / $52.58	Professional	26	$22.26	$30.93	$52.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $105.37 / $160.27 / $267.97	Professional	TC	$105.37	$160.27	$267.97
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $53.90 / $111.06 / $174.32	Facility	26	$53.90	$111.06	$174.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,035.17 / $1,037.03 / $1,063.54	Professional		$1,035.17	$1,037.03	$1,063.54
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $303.79 / $303.79 / $303.79	Professional	26	$303.79	$303.79	$303.79
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $848.18 / $922.24 / $947.51	Professional	TC	$848.18	$922.24	$947.51
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $135.84	Professional		$32.34	$32.34	$135.84
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $136.34 / $216.89 / $379.81	Professional		$136.34	$216.89	$379.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.70 / $29.15 / $62.45	Professional	26	$20.70	$29.15	$62.45
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $113.29 / $173.76 / $328.65	Professional	TC	$113.29	$173.76	$328.65
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $429.52 / $429.52 / $429.52	Professional		$429.52	$429.52	$429.52
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $79.59 / $79.59 / $79.59	Professional	26	$79.59	$79.59	$79.59
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $349.91 / $349.91 / $349.91	Professional	TC	$349.91	$349.91	$349.91
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $96.70 / $148.72 / $196.85	Professional		$96.70	$148.72	$196.85
United Facility/Professional Professional Modifier Low / Median / High Price $104.11 / $163.87 / $418.38	Professional		$104.11	$163.87	$418.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.87 / $25.98 / $66.11	Professional	26	$17.87	$25.98	$66.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.76 / $136.16 / $318.82	Professional	TC	$81.76	$136.16	$318.82