Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.18 / $15.81 / $95.87	Facility	26	$15.18	$15.81	$95.87
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.58 / $104.38 / $207.95	Facility	TC	$28.58	$104.38	$207.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.88 / $44.39 / $233.89	Professional		$36.88	$44.39	$233.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.29 / $15.18 / $69.43	Professional	26	$13.29	$15.18	$69.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.98 / $27.17 / $58.20	Professional	TC	$22.98	$27.17	$58.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.95 / $80.68 / $124.53	Professional		$45.95	$80.68	$124.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.12 / $17.97 / $17.97	Professional	26	$11.12	$17.97	$17.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.96 / $80.61 / $142.19	Professional		$41.96	$80.61	$142.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.60 / $30.08 / $51.90	Professional	26	$15.60	$30.08	$51.90
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $51.39 / $91.46	Professional	TC	$28.51	$51.39	$91.46
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $38.54 / $50.54 / $118.22	Professional		$38.54	$50.54	$118.22
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.60 / $18.70 / $46.05	Professional	26	$13.60	$18.70	$46.05
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.33 / $32.04 / $86.24	Professional	TC	$24.33	$32.04	$86.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $16.60 / $16.60	Facility	26	$16.60	$16.60	$16.60
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 $38.03 / $56.13 / $123.08	Professional		$38.03	$56.13	$123.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.63 / $20.45 / $43.72	Professional	26	$13.63	$20.45	$43.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.47 / $36.25 / $84.64	Professional	TC	$24.47	$36.25	$84.64
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $37.78 / $58.93 / $79.56	Professional		$37.78	$58.93	$79.56
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.98 / $16.55 / $22.36	Professional	26	$13.98	$16.55	$22.36
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.80 / $42.37 / $57.20	Professional	TC	$23.80	$42.37	$57.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $43.40 / $58.72 / $97.52	Professional		$43.40	$58.72	$97.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.59 / $19.87 / $31.47	Professional	26	$14.59	$19.87	$31.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.90 / $49.07 / $79.53	Professional	TC	$33.90	$49.07	$79.53
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $72.72 / $72.72	Facility	26	$50.00	$72.72	$72.72
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $60.70 / $169.86 / $169.86	Facility	TC	$60.70	$169.86	$169.86
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $297.38 / $297.38 / $382.35	Professional		$297.38	$297.38	$382.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.99 / $93.99 / $118.05	Professional	26	$93.99	$93.99	$118.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $203.39 / $203.39 / $264.23	Professional	TC	$203.39	$203.39	$264.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $34.95	Professional		$32.34	$32.34	$34.95
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $16.60 / $16.60	Facility	26	$16.60	$16.60	$16.60
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 $39.70 / $63.06 / $123.99	Professional		$39.70	$63.06	$123.99
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.66 / $20.16 / $43.72	Professional	26	$13.66	$20.16	$43.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.57 / $36.18 / $81.15	Professional	TC	$24.57	$36.18	$81.15
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $148.80 / $148.80 / $148.80	Professional		$148.80	$148.80	$148.80
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $53.18 / $53.18 / $53.18	Professional	26	$53.18	$53.18	$53.18
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $95.61 / $95.61 / $95.61	Professional	TC	$95.61	$95.61	$95.61
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $47.66 / $53.62 / $65.54	Professional		$47.66	$53.62	$65.54
United Facility/Professional Professional Modifier Low / Median / High Price $33.53 / $45.47 / $110.79	Professional		$33.53	$45.47	$110.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.07 / $17.43 / $41.06	Professional	26	$13.07	$17.43	$41.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.46 / $29.13 / $80.90	Professional	TC	$20.46	$29.13	$80.90