Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.73 / $11.79 / $65.94	Facility	26	$10.73	$11.79	$65.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.40 / $42.79 / $184.33	Professional		$33.40	$42.79	$184.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.88 / $11.79 / $48.32	Professional	26	$9.88	$11.79	$48.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.67 / $29.25 / $81.93	Professional	TC	$23.67	$29.25	$81.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $31.09 / $45.93 / $67.98	Professional		$31.09	$45.93	$67.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.69 / $8.82 / $16.19	Professional	26	$7.69	$8.82	$16.19
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.96 / $30.96 / $30.96	Professional	TC	$30.96	$30.96	$30.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.15 / $50.98 / $101.81	Professional		$38.15	$50.98	$101.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.57 / $16.21 / $31.59	Professional	26	$12.57	$16.21	$31.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.61 / $34.88 / $69.18	Professional	TC	$25.61	$34.88	$69.18
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $35.83 / $46.10 / $102.20	Professional		$35.83	$46.10	$102.20
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.63 / $14.88 / $33.81	Professional	26	$11.63	$14.88	$33.81
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.96 / $31.43 / $76.80	Professional	TC	$24.96	$31.43	$76.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.58 / $49.94 / $105.00	Professional		$33.58	$49.94	$105.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.92 / $14.73 / $31.09	Professional	26	$9.92	$14.73	$31.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $35.64 / $76.59	Professional	TC	$22.51	$35.64	$76.59
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $33.35 / $48.88 / $65.98	Professional		$33.35	$48.88	$65.98
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.67 / $11.56 / $15.61	Professional	26	$10.67	$11.56	$15.61
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.68 / $37.32 / $50.38	Professional	TC	$22.68	$37.32	$50.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.90 / $48.56 / $78.97	Professional		$35.90	$48.56	$78.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $13.87 / $21.73	Professional	26	$10.23	$13.87	$21.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.86 / $43.23 / $70.08	Professional	TC	$29.86	$43.23	$70.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $34.36 / $100.00 / $100.00	Facility	26	$34.36	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $262.00 / $262.00 / $316.64	Professional		$262.00	$262.00	$316.64
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.32 / $107.32 / $107.32	Professional	26	$107.32	$107.32	$107.32
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $233.18 / $249.00 / $249.00	Professional	TC	$233.18	$249.00	$249.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.19 / $32.34 / $32.34	Professional		$30.19	$32.34	$32.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $33.89 / $56.03 / $104.51	Professional		$33.89	$56.03	$104.51
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.96 / $14.43 / $30.64	Professional	26	$9.96	$14.43	$30.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.71 / $35.60 / $75.13	Professional	TC	$22.71	$35.60	$75.13
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $121.60 / $121.60 / $121.60	Professional		$121.60	$121.60	$121.60
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $36.79 / $36.79 / $36.79	Professional	26	$36.79	$36.79	$36.79
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $84.79 / $84.79 / $84.79	Professional	TC	$84.79	$84.79	$84.79
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $39.53 / $54.35 / $91.01	Professional		$39.53	$54.35	$91.01
United Facility/Professional Professional Modifier Low / Median / High Price $30.69 / $40.15 / $122.97	Professional		$30.69	$40.15	$122.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.24 / $12.87 / $30.13	Professional	26	$9.24	$12.87	$30.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $28.18 / $68.70	Professional	TC	$21.88	$28.18	$68.70