Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.61 / $17.54 / $78.13	Facility	26	$13.61	$17.54	$78.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.71 / $73.14 / $219.12	Professional		$47.71	$73.14	$219.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.98 / $18.32 / $63.00	Professional	26	$12.98	$18.32	$63.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.09 / $42.51 / $136.00	Professional	TC	$34.09	$42.51	$136.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $44.57 / $70.98 / $143.91	Professional		$44.57	$70.98	$143.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.68 / $16.28 / $29.72	Professional	26	$9.68	$16.28	$29.72
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.43 / $48.44 / $86.83	Professional	TC	$28.43	$48.44	$86.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.64 / $66.31 / $131.07	Professional		$49.64	$66.31	$131.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.38 / $20.25 / $38.94	Professional	26	$15.38	$20.25	$38.94
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.59 / $45.99 / $94.90	Professional	TC	$34.59	$45.99	$94.90
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $42.77 / $56.46 / $133.77	Professional		$42.77	$56.46	$133.77
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.88 / $18.39 / $42.34	Professional	26	$13.88	$18.39	$42.34
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $29.54 / $38.04 / $100.00	Professional	TC	$29.54	$38.04	$100.00
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 $43.23 / $66.42 / $136.09	Professional		$43.23	$66.42	$136.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.21 / $18.38 / $38.38	Professional	26	$12.21	$18.38	$38.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.97 / $47.86 / $109.23	Professional	TC	$31.97	$47.86	$109.23
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $70.84 / $95.63	Professional		$40.00	$70.84	$95.63
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.20 / $14.70 / $19.85	Professional	26	$13.20	$14.70	$19.85
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.80 / $56.14 / $75.79	Professional	TC	$26.80	$56.14	$75.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.77 / $70.05 / $116.34	Professional		$51.77	$70.05	$116.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.93 / $17.64 / $27.92	Professional	26	$12.93	$17.64	$27.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.91 / $64.97 / $105.34	Professional	TC	$44.91	$64.97	$105.34
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.72 / $110.00 / $110.00	Facility	26	$41.72	$110.00	$110.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $343.08 / $343.08 / $453.98	Professional		$343.08	$343.08	$453.98
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $113.92 / $113.92 / $113.92	Professional	26	$113.92	$113.92	$113.92
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $259.85 / $259.85 / $349.13	Professional	TC	$259.85	$259.85	$349.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $44.49	Professional		$32.34	$32.34	$44.49
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 $44.61 / $72.11 / $142.86	Professional		$44.61	$72.11	$142.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.23 / $18.10 / $38.38	Professional	26	$12.23	$18.10	$38.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.11 / $47.83 / $105.71	Professional	TC	$32.11	$47.83	$105.71
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $168.23 / $168.23 / $168.23	Professional		$168.23	$168.23	$168.23
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $44.97 / $44.97 / $44.97	Professional	26	$44.97	$44.97	$44.97
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $123.26 / $123.26 / $123.26	Professional	TC	$123.26	$123.26	$123.26
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $57.29 / $78.77 / $105.54	Professional		$57.29	$78.77	$105.54
United Facility/Professional Professional Modifier Low / Median / High Price $38.94 / $54.51 / $141.10	Professional		$38.94	$54.51	$141.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.17 / $16.22 / $40.84	Professional	26	$12.17	$16.22	$40.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.14 / $38.79 / $95.23	Professional	TC	$28.14	$38.79	$95.23