Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $18.62 / $35.48	Facility	26	$13.80	$18.62	$35.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $77.62 / $229.09	Professional		$48.98	$77.62	$229.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $21.38 / $61.66	Professional	26	$12.59	$21.38	$61.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $48.98 / $134.90	Professional	TC	$33.88	$48.98	$134.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $56.23 / $114.82	Professional		$40.74	$56.23	$114.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $21.38 / $29.51	Professional	26	$10.47	$21.38	$29.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.90 / $75.86	Professional	TC	$28.84	$38.90	$75.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $74.13 / $144.54	Professional		$52.48	$74.13	$144.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $21.88 / $39.81	Professional	26	$16.22	$21.88	$39.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $51.29 / $102.33	Professional	TC	$38.02	$51.29	$102.33
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $72.44 / $144.54	Professional		$50.12	$72.44	$144.54
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $21.88 / $38.02	Professional	26	$16.98	$21.88	$38.02
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $48.98 / $109.65	Professional	TC	$33.11	$48.98	$109.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.16 / $14.79 / $21.38	Facility	26	$3.16	$14.79	$21.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $66.07 / $123.03	Professional		$43.65	$66.07	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $18.62 / $34.67	Professional	26	$12.02	$18.62	$34.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $47.86 / $91.20	Professional	TC	$31.62	$47.86	$91.20
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $74.13 / $100.00	Professional		$39.81	$74.13	$100.00
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $15.14 / $20.42	Professional	26	$13.18	$15.14	$20.42
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $58.88 / $79.43	Professional	TC	$26.92	$58.88	$79.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $69.18 / $123.03	Professional		$53.70	$69.18	$123.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $17.38 / $28.18	Professional	26	$12.88	$17.38	$28.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $63.10 / $112.20	Professional	TC	$48.98	$63.10	$112.20
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $457.09 / $457.09	Professional		$346.74	$457.09	$457.09
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Professional	26	$114.82	$114.82	$114.82
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $346.74 / $346.74	Professional	TC	$257.04	$346.74	$346.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.49 / $33.11 / $60.26	Professional		$15.49	$33.11	$60.26
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.16 / $14.79 / $21.38	Facility	26	$3.16	$14.79	$21.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $67.61 / $131.83	Professional		$43.65	$67.61	$131.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.78 / $33.88	Professional	26	$11.75	$17.78	$33.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $45.71 / $87.10	Professional	TC	$31.62	$45.71	$87.10
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $53.70 / $169.82	Professional		$53.70	$53.70	$169.82
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $44.67 / $44.67	Professional	26	$44.67	$44.67	$44.67
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $123.03 / $123.03	Professional	TC	$123.03	$123.03	$123.03
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $81.28 / $104.71	Professional		$60.26	$81.28	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $51.29 / $109.65	Professional		$38.90	$51.29	$109.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $14.79 / $28.84	Professional	26	$10.72	$14.79	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $37.15 / $81.28	Professional	TC	$28.18	$37.15	$81.28