Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $16.22 / $79.43	Facility	26	$12.02	$16.22	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $57.54 / $234.42	Professional		$38.02	$57.54	$234.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.78 / $48.98	Professional	26	$10.96	$17.78	$48.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $37.15 / $102.33	Professional	TC	$26.30	$37.15	$102.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $47.86 / $63.10	Professional		$35.48	$47.86	$63.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $21.38 / $21.38	Professional	26	$21.38	$21.38	$21.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $63.10 / $123.03	Professional		$45.71	$63.10	$123.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $19.95 / $38.02	Professional	26	$14.79	$19.95	$38.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $42.66 / $87.10	Professional	TC	$30.90	$42.66	$87.10
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $64.57 / $125.89	Professional		$46.77	$64.57	$125.89
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.50 / $36.31	Professional	26	$15.14	$19.50	$36.31
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $44.67 / $91.20	Professional	TC	$31.62	$44.67	$91.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.24 / $15.14 / $21.88	Facility	26	$3.24	$15.14	$21.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $58.88 / $107.15	Professional		$38.90	$58.88	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.38 / $34.67	Professional	26	$11.75	$17.38	$34.67
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 $38.02 / $63.10 / $85.11	Professional		$38.02	$63.10	$85.11
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $15.14 / $20.42	Professional	26	$12.02	$15.14	$20.42
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $46.77 / $63.10	Professional	TC	$25.70	$46.77	$63.10
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 $13.49 / $17.38 / $28.84	Professional	26	$13.49	$17.38	$28.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $51.29 / $89.13	Professional	TC	$38.90	$51.29	$89.13
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 $398.11 / $398.11 / $436.52	Professional		$398.11	$398.11	$436.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $107.15 / $107.15	Professional	26	$97.72	$107.15	$107.15
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $295.12 / $426.58	Professional	TC	$295.12	$295.12	$426.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $33.11 / $53.70	Professional		$15.85	$33.11	$53.70
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.24 / $15.14 / $21.88	Facility	26	$3.24	$15.14	$21.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $61.66 / $120.23	Professional		$39.81	$61.66	$120.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $16.60 / $32.36	Professional	26	$11.75	$16.60	$32.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $38.90 / $77.62	Professional	TC	$27.54	$38.90	$77.62
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $154.88 / $154.88	Professional		$154.88	$154.88	$154.88
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $45.71 / $45.71	Professional	26	$45.71	$45.71	$45.71
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 $33.88 / $46.77 / $100.00	Professional		$33.88	$46.77	$100.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $14.45 / $28.84	Professional	26	$10.47	$14.45	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.11 / $70.79	Professional	TC	$23.44	$33.11	$70.79