Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $12.59 / $28.18	Facility	26	$9.33	$12.59	$28.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $57.54 / $194.98	Professional		$33.88	$57.54	$194.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $15.49 / $44.67	Professional	26	$9.33	$15.49	$44.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $37.15 / $134.90	Professional	TC	$23.99	$37.15	$134.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $43.65 / $89.13	Professional		$25.12	$43.65	$89.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $17.38 / $24.55	Professional	26	$10.00	$17.38	$24.55
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $26.92 / $64.57	Professional	TC	$20.42	$26.92	$64.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $54.95 / $107.15	Professional		$39.81	$54.95	$107.15
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $15.49 / $29.51	Professional	26	$11.75	$15.49	$29.51
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $39.81 / $74.13	Professional	TC	$27.54	$39.81	$74.13
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $54.95 / $107.15	Professional		$38.90	$54.95	$107.15
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $15.14 / $28.18	Professional	26	$11.75	$15.14	$28.18
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $38.90 / $79.43	Professional	TC	$26.92	$38.90	$79.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $48.98 / $93.33	Professional		$32.36	$48.98	$93.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $13.80 / $26.92	Professional	26	$9.33	$13.80	$26.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $35.48 / $67.61	Professional	TC	$22.91	$35.48	$67.61
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $51.29 / $69.18	Professional		$30.90	$51.29	$69.18
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $12.02 / $16.22	Professional	26	$9.33	$12.02	$16.22
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $39.81 / $53.70	Professional	TC	$21.38	$39.81	$53.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $48.98 / $87.10	Professional		$38.02	$48.98	$87.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $13.80 / $22.39	Professional	26	$10.23	$13.80	$22.39
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $42.66 / $74.13	Professional	TC	$33.11	$42.66	$74.13
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $331.13 / $331.13	Professional		$251.19	$331.13	$331.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	26	$93.33	$93.33	$93.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $245.47 / $245.47	Professional	TC	$223.87	$245.47	$245.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $32.36 / $44.67	Professional		$12.88	$32.36	$44.67
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $52.48 / $100.00	Professional		$33.11	$52.48	$100.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $12.88 / $25.12	Professional	26	$9.12	$12.88	$25.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $34.67 / $64.57	Professional	TC	$22.91	$34.67	$64.57
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Professional		$128.82	$128.82	$128.82
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $38.02 / $38.02	Professional	26	$38.02	$38.02	$38.02
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $89.13 / $89.13	Professional	TC	$89.13	$89.13	$89.13
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $57.54 / $83.18	Professional		$42.66	$57.54	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $38.90 / $83.18	Professional		$29.51	$38.90	$83.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $12.02 / $23.99	Professional	26	$8.32	$12.02	$23.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $27.54 / $58.88	Professional	TC	$21.38	$27.54	$58.88