Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.49 / $16.14 / $85.06	Facility	26	$14.49	$16.14	$85.06
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $36.65 / $134.77 / $320.41	Facility	TC	$36.65	$134.77	$320.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.65 / $51.64 / $229.53	Professional		$40.65	$51.64	$229.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.00 / $16.14 / $76.88	Professional	26	$13.00	$16.14	$76.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.85 / $33.06 / $93.71	Professional	TC	$26.85	$33.06	$93.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.90 / $45.05 / $58.63	Professional		$36.90	$45.05	$58.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.94 / $10.68 / $30.26	Professional	26	$9.94	$10.68	$30.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.36 / $61.89 / $123.57	Professional		$47.36	$61.89	$123.57
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.12 / $21.64 / $41.13	Professional	26	$17.12	$21.64	$41.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.04 / $39.70 / $79.28	Professional	TC	$29.04	$39.70	$79.28
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $43.30 / $56.02 / $124.10	Professional		$43.30	$56.02	$124.10
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.14 / $20.54 / $46.22	Professional	26	$16.14	$20.54	$46.22
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $28.43 / $35.70 / $93.49	Professional	TC	$28.43	$35.70	$93.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.41 / $15.41 / $15.41	Facility	26	$15.41	$15.41	$15.41
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.04 / $35.04 / $35.04	Facility	TC	$35.04	$35.04	$35.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.47 / $60.24 / $126.34	Professional		$40.47	$60.24	$126.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.75 / $20.05 / $40.42	Professional	26	$12.75	$20.05	$40.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.86 / $41.03 / $87.92	Professional	TC	$25.86	$41.03	$87.92
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $40.22 / $57.88 / $78.14	Professional		$40.22	$57.88	$78.14
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.88 / $15.05 / $20.32	Professional	26	$14.88	$15.05	$20.32
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.34 / $42.83 / $57.82	Professional	TC	$25.34	$42.83	$57.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.54 / $57.21 / $98.00	Professional		$42.54	$57.21	$98.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.25 / $18.05 / $28.29	Professional	26	$13.25	$18.05	$28.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.26 / $49.59 / $80.41	Professional	TC	$34.26	$49.59	$80.41
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.08 / $100.00 / $100.00	Facility	26	$49.08	$100.00	$100.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $171.67 / $171.67	Facility	TC	$100.00	$171.67	$171.67
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $314.00 / $314.00 / $374.55	Professional		$314.00	$314.00	$374.55
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.32 / $107.32 / $107.48	Professional	26	$107.32	$107.32	$107.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $267.08 / $296.00 / $296.00	Professional	TC	$267.08	$296.00	$296.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $34.59	Professional		$32.34	$32.34	$34.59
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.41 / $15.41 / $15.41	Facility	26	$15.41	$15.41	$15.41
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $35.04 / $35.04 / $35.04	Facility	TC	$35.04	$35.04	$35.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $40.59 / $67.50 / $124.49	Professional		$40.59	$67.50	$124.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.84 / $19.61 / $40.42	Professional	26	$12.84	$19.61	$40.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.04 / $41.03 / $86.84	Professional	TC	$26.04	$41.03	$86.84
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $146.55 / $146.55 / $146.55	Professional		$146.55	$146.55	$146.55
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $47.32 / $47.32 / $47.32	Professional	26	$47.32	$47.32	$47.32
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $99.22 / $99.22 / $99.22	Professional	TC	$99.22	$99.22	$99.22
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $46.81 / $64.36 / $111.78	Professional		$46.81	$64.36	$111.78
United Facility/Professional Professional Modifier Low / Median / High Price $37.51 / $50.24 / $121.49	Professional		$37.51	$50.24	$121.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.72 / $17.13 / $38.76	Professional	26	$12.72	$17.13	$38.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.29 / $32.95 / $76.65	Professional	TC	$25.29	$32.95	$76.65