Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $29.51 / $91.20	Facility	26	$14.45	$29.51	$91.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $45.71 / $117.49 / $199.53	Facility	TC	$45.71	$117.49	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $53.70 / $245.47	Professional		$37.15	$53.70	$245.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.98 / $72.44	Professional	26	$12.88	$16.98	$72.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $29.51 / $79.43	Professional	TC	$22.91	$29.51	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $12.88 / $125.89	Professional		$12.88	$12.88	$125.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $89.13 / $144.54	Professional		$51.29	$89.13	$144.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $33.11 / $51.29	Professional	26	$19.95	$33.11	$51.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $56.23 / $93.33	Professional	TC	$34.67	$56.23	$93.33
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $64.57 / $125.89	Professional		$44.67	$64.57	$125.89
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $23.99 / $44.67	Professional	26	$16.98	$23.99	$44.67
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $39.81 / $81.28	Professional	TC	$27.54	$39.81	$81.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.63 / $16.98 / $23.99	Facility	26	$3.63	$16.98	$23.99
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $7.24 / $33.88 / $47.86	Facility	TC	$7.24	$33.88	$47.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $56.23 / $104.71	Professional		$38.02	$56.23	$104.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $20.42 / $38.90	Professional	26	$13.49	$20.42	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $35.48 / $72.44	Professional	TC	$24.55	$35.48	$72.44
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $58.88 / $79.43	Professional		$38.02	$58.88	$79.43
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $16.98 / $22.91	Professional	26	$14.13	$16.98	$22.91
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $42.66 / $57.54	Professional	TC	$23.99	$42.66	$57.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $56.23 / $95.50	Professional		$43.65	$56.23	$95.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $19.50 / $31.62	Professional	26	$14.79	$19.50	$31.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $45.71 / $79.43	Professional	TC	$35.48	$45.71	$79.43
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Facility	26	$93.33	$93.33	$93.33
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $204.17 / $204.17 / $204.17	Facility	TC	$204.17	$204.17	$204.17
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $380.19 / $380.19	Professional		$295.12	$380.19	$380.19
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $117.49 / $117.49	Professional	26	$93.33	$117.49	$117.49
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $263.03 / $263.03	Professional	TC	$204.17	$263.03	$263.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $33.11 / $52.48	Professional		$17.38	$33.11	$52.48
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.63 / $16.98 / $23.99	Facility	26	$3.63	$16.98	$23.99
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $7.24 / $33.88 / $47.86	Facility	TC	$7.24	$33.88	$47.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $58.88 / $114.82	Professional		$38.02	$58.88	$114.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $19.05 / $36.31	Professional	26	$13.18	$19.05	$36.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.88 / $70.79	Professional	TC	$23.99	$33.88	$70.79
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $147.91 / $147.91	Professional		$147.91	$147.91	$147.91
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $53.70 / $53.70	Professional	26	$53.70	$53.70	$53.70
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	TC	$95.50	$95.50	$95.50
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $52.48 / $66.07	Professional		$38.02	$52.48	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $45.71 / $95.50	Professional		$33.88	$45.71	$95.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $16.60 / $33.88	Professional	26	$12.59	$16.60	$33.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.84 / $63.10	Professional	TC	$20.42	$28.84	$63.10