Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.19 / $12.80 / $87.00	Facility	26	$12.19	$12.80	$87.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.88 / $46.04 / $212.59	Professional		$36.88	$46.04	$212.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.50 / $13.67 / $46.59	Professional	26	$11.50	$13.67	$46.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.32 / $31.08 / $116.19	Professional	TC	$24.32	$31.08	$116.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.47 / $46.40 / $62.13	Professional		$41.47	$46.40	$62.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.19 / $10.95 / $31.04	Professional	26	$10.19	$10.95	$31.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $52.96 / $105.75	Professional		$40.74	$52.96	$105.75
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.11 / $17.80 / $34.81	Professional	26	$14.11	$17.80	$34.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $35.76 / $70.19	Professional	TC	$26.62	$35.76	$70.19
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $36.74 / $46.46 / $108.95	Professional		$36.74	$46.46	$108.95
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.62 / $16.14 / $37.22	Professional	26	$12.62	$16.14	$37.22
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.04 / $30.72 / $84.18	Professional	TC	$24.04	$30.72	$84.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.80 / $15.80 / $15.80	Facility	26	$15.80	$15.80	$15.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.13 / $54.57 / $114.03	Professional		$36.13	$54.57	$114.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.00 / $16.98 / $36.97	Professional	26	$12.00	$16.98	$36.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.26 / $37.59 / $83.17	Professional	TC	$24.26	$37.59	$83.17
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $33.31 / $56.39 / $76.13	Professional		$33.31	$56.39	$76.13
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.66 / $15.40 / $20.79	Professional	26	$11.66	$15.40	$20.79
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.65 / $40.99 / $55.34	Professional	TC	$21.65	$40.99	$55.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $41.51 / $56.17 / $93.28	Professional		$41.51	$56.17	$93.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.58 / $18.48 / $29.25	Professional	26	$13.58	$18.48	$29.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $47.48 / $76.95	Professional	TC	$32.79	$47.48	$76.95
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 $282.23 / $282.23 / $365.85	Professional		$282.23	$282.23	$365.85
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.72 / $100.72 / $110.03	Professional	26	$100.72	$100.72	$110.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $254.00 / $254.00 / $255.75	Professional	TC	$254.00	$254.00	$255.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $33.49	Professional		$32.34	$32.34	$33.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.80 / $15.80 / $15.80	Facility	26	$15.80	$15.80	$15.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $37.49 / $60.05 / $117.70	Professional		$37.49	$60.05	$117.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.00 / $16.53 / $36.75	Professional	26	$12.00	$16.53	$36.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.26 / $36.99 / $79.88	Professional	TC	$24.26	$36.99	$79.88
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $142.88 / $142.88 / $142.88	Professional		$142.88	$142.88	$142.88
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $48.47 / $48.47 / $48.47	Professional	26	$48.47	$48.47	$48.47
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $94.41 / $94.41 / $94.41	Professional	TC	$94.41	$94.41	$94.41
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $45.61 / $62.71 / $93.15	Professional		$45.61	$62.71	$93.15
United Facility/Professional Professional Modifier Low / Median / High Price $31.83 / $44.57 / $107.83	Professional		$31.83	$44.57	$107.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $15.16 / $36.13	Professional	26	$10.23	$15.16	$36.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.17 / $30.42 / $73.44	Professional	TC	$22.17	$30.42	$73.44