Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.71 / $17.43 / $88.94	Facility	26	$16.71	$17.43	$88.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.02 / $80.52 / $303.22	Professional		$58.02	$80.52	$303.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.01 / $17.43 / $74.17	Professional	26	$14.01	$17.43	$74.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.86 / $51.20 / $214.00	Professional	TC	$42.86	$51.20	$214.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $62.88 / $88.04 / $138.25	Professional		$62.88	$88.04	$138.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.59 / $11.88 / $32.07	Professional	26	$8.59	$11.88	$32.07
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.33 / $56.33 / $56.33	Professional	TC	$56.33	$56.33	$56.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.85 / $82.38 / $161.75	Professional		$59.85	$82.38	$161.75
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.44 / $23.47 / $45.25	Professional	26	$17.44	$23.47	$45.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.78 / $59.09 / $114.86	Professional	TC	$41.78	$59.09	$114.86
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $54.05 / $71.23 / $170.17	Professional		$54.05	$71.23	$170.17
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.78 / $21.34 / $49.11	Professional	26	$16.78	$21.34	$49.11
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $38.47 / $49.51 / $126.14	Professional	TC	$38.47	$49.51	$126.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.15 / $80.69 / $166.45	Professional		$51.15	$80.69	$166.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.83 / $21.06 / $42.35	Professional	26	$13.83	$21.06	$42.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.17 / $60.49 / $131.61	Professional	TC	$38.17	$60.49	$131.61
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $50.31 / $81.22 / $109.65	Professional		$50.31	$81.22	$109.65
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.60 / $15.89 / $21.45	Professional	26	$15.60	$15.89	$21.45
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.71 / $65.31 / $88.18	Professional	TC	$34.71	$65.31	$88.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $59.39 / $79.89 / $128.96	Professional		$59.39	$79.89	$128.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.09 / $19.07 / $30.17	Professional	26	$14.09	$19.07	$30.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $52.26 / $75.56 / $122.54	Professional	TC	$52.26	$75.56	$122.54
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.08 / $126.00 / $126.00	Facility	26	$49.08	$126.00	$126.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $399.42 / $399.42 / $522.38	Professional		$399.42	$399.42	$522.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $137.04 / $137.04 / $220.00	Professional	26	$137.04	$137.04	$220.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $356.00 / $356.00 / $405.68	Professional	TC	$356.00	$356.00	$405.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $52.93	Professional		$32.34	$32.34	$52.93
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $53.89 / $89.09 / $166.30	Professional		$53.89	$89.09	$166.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.01 / $21.00 / $42.35	Professional	26	$14.01	$21.00	$42.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $38.51 / $59.60 / $127.99	Professional	TC	$38.51	$59.60	$127.99
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $198.14 / $198.14 / $198.14	Professional		$198.14	$198.14	$198.14
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $49.63 / $49.63 / $49.63	Professional	26	$49.63	$49.63	$49.63
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $148.51 / $148.51 / $148.51	Professional	TC	$148.51	$148.51	$148.51
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $65.68 / $90.31 / $130.60	Professional		$65.68	$90.31	$130.60
United Facility/Professional Professional Modifier Low / Median / High Price $48.88 / $67.94 / $171.54	Professional		$48.88	$67.94	$171.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.96 / $18.39 / $39.52	Professional	26	$13.96	$18.39	$39.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.81 / $49.23 / $115.45	Professional	TC	$35.81	$49.23	$115.45