Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.19 / $13.93 / $78.19	Facility	26	$12.19	$13.93	$78.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.96 / $52.25 / $182.00	Professional		$33.96	$52.25	$182.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.50 / $15.34 / $59.33	Professional	26	$11.50	$15.34	$59.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.12 / $33.82 / $92.25	Professional	TC	$24.12	$33.82	$92.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.70 / $59.80 / $113.68	Professional		$34.70	$59.80	$113.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.44 / $16.00 / $28.89	Professional	26	$9.44	$16.00	$28.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.58 / $60.88 / $60.88	Professional	TC	$53.58	$60.88	$60.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.86 / $50.19 / $98.48	Professional		$38.86	$50.19	$98.48
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.95 / $17.80 / $34.52	Professional	26	$13.95	$17.80	$34.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.46 / $33.17 / $67.09	Professional	TC	$25.46	$33.17	$67.09
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $35.56 / $44.93 / $105.21	Professional		$35.56	$44.93	$105.21
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.54 / $15.86 / $36.67	Professional	26	$12.54	$15.86	$36.67
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $22.77 / $28.80 / $75.39	Professional	TC	$22.77	$28.80	$75.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.58 / $51.58 / $109.51	Professional		$34.58	$51.58	$109.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.30 / $16.23 / $35.71	Professional	26	$11.30	$16.23	$35.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.58 / $35.21 / $80.28	Professional	TC	$23.58	$35.21	$80.28
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $32.32 / $54.31 / $73.31	Professional		$32.32	$54.31	$73.31
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.64 / $14.24 / $19.22	Professional	26	$11.64	$14.24	$19.22
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.68 / $40.08 / $54.11	Professional	TC	$20.68	$40.08	$54.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.96 / $54.06 / $89.79	Professional		$39.96	$54.06	$89.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.57 / $17.09 / $26.77	Professional	26	$12.57	$17.09	$26.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.06 / $46.41 / $75.23	Professional	TC	$32.06	$46.41	$75.23
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.72 / $100.00 / $100.00	Facility	26	$41.72	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $271.47 / $271.47 / $352.20	Professional		$271.47	$271.47	$352.20
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $94.11 / $94.11 / $102.08	Professional	26	$94.11	$94.11	$102.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $227.00 / $227.00 / $250.13	Professional	TC	$227.00	$227.00	$250.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.75	Professional		$32.34	$32.34	$32.75
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $35.45 / $56.68 / $113.21	Professional		$35.45	$56.68	$113.21
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.40 / $16.00 / $35.54	Professional	26	$11.40	$16.00	$35.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.65 / $34.69 / $75.94	Professional	TC	$23.65	$34.69	$75.94
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $135.78 / $135.78 / $135.78	Professional		$135.78	$135.78	$135.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $43.77 / $43.77 / $43.77	Professional	26	$43.77	$43.77	$43.77
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $92.01 / $92.01 / $92.01	Professional	TC	$92.01	$92.01	$92.01
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $43.92 / $60.39 / $104.33	Professional		$43.92	$60.39	$104.33
United Facility/Professional Professional Modifier Low / Median / High Price $29.84 / $43.72 / $101.37	Professional		$29.84	$43.72	$101.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.24 / $14.40 / $38.08	Professional	26	$10.24	$14.40	$38.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.18 / $28.25 / $71.09	Professional	TC	$20.18	$28.25	$71.09