Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $14.79 / $37.15	Facility	26	$10.96	$14.79	$37.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $66.07 / $208.93	Professional		$37.15	$66.07	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.38 / $57.54	Professional	26	$10.96	$17.38	$57.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $43.65 / $147.91	Professional	TC	$26.92	$43.65	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $38.90 / $91.20	Professional		$33.88	$38.90	$91.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $19.95 / $58.88	Professional	26	$10.00	$19.95	$58.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $32.36 / $74.13	Professional	TC	$27.54	$32.36	$74.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $60.26 / $117.49	Professional		$43.65	$60.26	$117.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $18.62 / $35.48	Professional	26	$13.80	$18.62	$35.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $41.69 / $85.11	Professional	TC	$30.20	$41.69	$85.11
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $63.10 / $120.23	Professional		$46.77	$63.10	$120.23
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $18.62 / $33.88	Professional	26	$14.13	$18.62	$33.88
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $43.65 / $91.20	Professional	TC	$31.62	$43.65	$91.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.02 / $14.13 / $20.42	Facility	26	$3.02	$14.13	$20.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $57.54 / $107.15	Professional		$38.90	$57.54	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $16.22 / $31.62	Professional	26	$11.22	$16.22	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $40.74 / $81.28	Professional	TC	$27.54	$40.74	$81.28
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $63.10 / $85.11	Professional		$37.15	$63.10	$85.11
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $14.45 / $19.50	Professional	26	$11.48	$14.45	$19.50
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $47.86 / $64.57	Professional	TC	$25.70	$47.86	$64.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $57.54 / $102.33	Professional		$45.71	$57.54	$102.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $16.60 / $26.92	Professional	26	$12.59	$16.60	$26.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $51.29 / $91.20	Professional	TC	$39.81	$51.29	$91.20
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $389.05 / $389.05	Professional		$309.03	$389.05	$389.05
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $100.00 / $100.00	Professional	26	$95.50	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $295.12 / $295.12	Professional	TC	$251.19	$295.12	$295.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.79 / $33.11 / $52.48	Professional		$14.79	$33.11	$52.48
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.02 / $14.13 / $20.42	Facility	26	$3.02	$14.13	$20.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $60.26 / $120.23	Professional		$38.90	$60.26	$120.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.14 / $30.90	Professional	26	$10.96	$15.14	$30.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $38.90 / $77.62	Professional	TC	$26.92	$38.90	$77.62
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Professional		$151.36	$151.36	$151.36
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	26	$43.65	$43.65	$43.65
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	TC	$109.65	$109.65	$109.65
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $70.79 / $93.33	Professional		$51.29	$70.79	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $46.77 / $97.72	Professional		$32.36	$46.77	$97.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $13.80 / $27.54	Professional	26	$9.55	$13.80	$27.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.11 / $70.79	Professional	TC	$23.44	$33.11	$70.79