Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $13.49 / $28.18	Facility	26	$10.00	$13.49	$28.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $50.12 / $173.78	Professional		$31.62	$50.12	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.45 / $40.74	Professional	26	$8.91	$14.45	$40.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $30.90 / $134.90	Professional	TC	$20.42	$30.90	$134.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $48.98 / $64.57	Professional		$21.88	$48.98	$64.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $17.38 / $22.39	Professional	26	$9.33	$17.38	$22.39
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $52.48 / $52.48	Professional	TC	$52.48	$52.48	$52.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $51.29 / $95.50	Professional		$36.31	$51.29	$95.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $15.49 / $30.20	Professional	26	$11.48	$15.49	$30.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $34.67 / $66.07	Professional	TC	$25.12	$34.67	$66.07
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $50.12 / $100.00	Professional		$33.88	$50.12	$100.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $16.22 / $28.18	Professional	26	$12.02	$16.22	$28.18
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $33.11 / $72.44	Professional	TC	$22.39	$33.11	$72.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.45 / $11.48 / $16.22	Facility	26	$2.45	$11.48	$16.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $45.71 / $87.10	Professional		$30.20	$45.71	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $13.80 / $26.92	Professional	26	$9.12	$13.80	$26.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $32.36 / $61.66	Professional	TC	$19.95	$32.36	$61.66
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $46.77 / $63.10	Professional		$27.54	$46.77	$63.10
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $11.75 / $15.85	Professional	26	$9.33	$11.75	$15.85
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $34.67 / $46.77	Professional	TC	$18.20	$34.67	$46.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $43.65 / $81.28	Professional		$33.88	$43.65	$81.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $13.49 / $21.88	Professional	26	$10.00	$13.49	$21.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.02 / $66.07	Professional	TC	$28.84	$38.02	$66.07
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 $223.87 / $288.40 / $288.40	Professional		$223.87	$288.40	$288.40
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 $208.93 / $208.93 / $208.93	Professional	TC	$208.93	$208.93	$208.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.02 / $32.36 / $38.90	Professional		$12.02	$32.36	$38.90
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.45 / $11.48 / $16.22	Facility	26	$2.45	$11.48	$16.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $48.98 / $89.13	Professional		$30.20	$48.98	$89.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $13.18 / $25.12	Professional	26	$9.12	$13.18	$25.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $30.90 / $56.23	Professional	TC	$19.95	$30.90	$56.23
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Professional		$112.20	$112.20	$112.20
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $35.48 / $35.48	Professional	26	$35.48	$35.48	$35.48
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $77.62 / $77.62	Professional	TC	$77.62	$77.62	$77.62
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $52.48 / $74.13	Professional		$38.02	$52.48	$74.13
United Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $36.31 / $72.44	Professional		$26.92	$36.31	$72.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $11.22 / $22.39	Professional	26	$7.76	$11.22	$22.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $24.55 / $51.29	Professional	TC	$19.50	$24.55	$51.29