Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.49 / $15.74 / $138.38	Facility	26	$14.49	$15.74	$138.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.93 / $138.93 / $544.00	Professional		$109.93	$138.93	$544.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.49 / $21.80 / $68.00	Professional	26	$14.49	$21.80	$68.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.56 / $106.95 / $284.31	Professional	TC	$94.56	$106.95	$284.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.57 / $160.94 / $252.37	Professional		$100.57	$160.94	$252.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.75 / $19.64 / $39.81	Professional	26	$16.75	$19.64	$39.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $118.49 / $173.97 / $334.50	Professional		$118.49	$173.97	$334.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.65 / $24.27 / $51.88	Professional	26	$15.65	$24.27	$51.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $101.97 / $149.29 / $290.73	Professional	TC	$101.97	$149.29	$290.73
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $116.41 / $192.79 / $461.95	Professional		$116.41	$192.79	$461.95
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $20.05 / $56.97	Professional	26	$15.85	$20.05	$56.97
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $104.08 / $173.49 / $409.55	Professional	TC	$104.08	$173.49	$409.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.70 / $26.70 / $26.70	Facility	26	$26.70	$26.70	$26.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.56 / $197.61 / $398.09	Professional		$133.56	$197.61	$398.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $27.81 / $64.67	Professional	26	$16.22	$27.81	$64.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.96 / $176.58 / $334.73	Professional	TC	$113.96	$176.58	$334.73
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $82.86 / $126.11 / $217.01	Professional		$82.86	$126.11	$217.01
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.39 / $24.60 / $33.21	Professional	26	$17.39	$24.60	$33.21
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.45 / $99.62 / $183.80	Professional	TC	$65.45	$99.62	$183.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $122.83 / $160.75 / $303.42	Professional		$122.83	$160.75	$303.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.07 / $30.75 / $52.16	Professional	26	$22.07	$30.75	$52.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $105.01 / $159.72 / $267.08	Professional	TC	$105.01	$159.72	$267.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $53.56 / $102.96 / $109.96	Facility	26	$53.56	$102.96	$109.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,021.59 / $1,030.20 / $1,049.58	Professional		$1,021.59	$1,030.20	$1,049.58
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $203.09 / $203.09 / $203.09	Professional	26	$203.09	$203.09	$203.09
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $845.33 / $934.78 / $960.39	Professional	TC	$845.33	$934.78	$960.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $134.94	Professional		$32.34	$32.34	$134.94
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.70 / $26.70 / $26.70	Facility	26	$26.70	$26.70	$26.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $135.57 / $214.15 / $373.07	Professional		$135.57	$214.15	$373.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $27.16 / $61.60	Professional	26	$16.22	$27.16	$61.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.13 / $176.58 / $329.59	Professional	TC	$114.13	$176.58	$329.59
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $431.18 / $431.18 / $431.18	Professional		$431.18	$431.18	$431.18
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $78.86 / $78.86 / $78.86	Professional	26	$78.86	$78.86	$78.86
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $352.32 / $352.32 / $352.32	Professional	TC	$352.32	$352.32	$352.32
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $105.09 / $161.63 / $213.94	Professional		$105.09	$161.63	$213.94
United Facility/Professional Professional Modifier Low / Median / High Price $105.56 / $163.81 / $419.98	Professional		$105.56	$163.81	$419.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.59 / $24.21 / $59.50	Professional	26	$14.59	$24.21	$59.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.32 / $136.02 / $307.52	Professional	TC	$82.32	$136.02	$307.52