Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.14 / $19.05 / $41.69	Facility	26	$15.14	$19.05	$41.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $95.50 / $295.12	Professional		$57.54	$95.50	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $23.99 / $72.44	Professional	26	$14.13	$23.99	$72.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $61.66 / $199.53	Professional	TC	$42.66	$61.66	$199.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $79.43 / $158.49	Professional		$52.48	$79.43	$158.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $26.92 / $81.28	Professional	26	$12.59	$26.92	$81.28
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $114.82 / $120.23	Professional	TC	$102.33	$114.82	$120.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $128.82 / $218.78	Professional		$79.43	$128.82	$218.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $30.90 / $50.12	Professional	26	$19.95	$30.90	$50.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $100.00 / $169.82	Professional	TC	$64.57	$100.00	$169.82
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $95.50 / $190.55	Professional		$66.07	$95.50	$190.55
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $8.91 / $23.44	Professional	26	$6.17	$8.91	$23.44
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $87.10 / $162.18	Professional	TC	$60.26	$87.10	$162.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.72 / $17.38 / $24.55	Facility	26	$3.72	$17.38	$24.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $83.18 / $162.18	Professional		$57.54	$83.18	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $20.42 / $38.90	Professional	26	$13.49	$20.42	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $64.57 / $128.82	Professional	TC	$42.66	$64.57	$128.82
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $97.72 / $131.83	Professional		$56.23	$97.72	$131.83
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $17.38 / $23.44	Professional	26	$14.13	$17.38	$23.44
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $79.43 / $107.15	Professional	TC	$42.66	$79.43	$107.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $91.20 / $158.49	Professional		$70.79	$91.20	$158.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.95 / $32.36	Professional	26	$15.14	$19.95	$32.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $85.11 / $151.36	Professional	TC	$66.07	$85.11	$151.36
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $95.50 / $95.50	Facility	26	$95.50	$95.50	$95.50
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $588.84 / $588.84	Professional		$457.09	$588.84	$588.84
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $123.03 / $123.03	Professional	26	$95.50	$123.03	$123.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $467.74 / $467.74	Professional	TC	$354.81	$467.74	$467.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $33.11 / $79.43	Professional		$17.78	$33.11	$79.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.72 / $17.38 / $24.55	Facility	26	$3.72	$17.38	$24.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $89.13 / $177.83	Professional		$57.54	$89.13	$177.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $19.05 / $37.15	Professional	26	$13.18	$19.05	$37.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $61.66 / $125.89	Professional	TC	$42.66	$61.66	$125.89
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $223.87	Professional		$72.44	$72.44	$223.87
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $52.48 / $52.48	Professional	26	$52.48	$52.48	$52.48
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $173.78 / $173.78	Professional	TC	$173.78	$173.78	$173.78
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $81.28 / $102.33	Professional		$56.23	$81.28	$102.33
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $69.18 / $144.54	Professional		$50.12	$69.18	$144.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $16.60 / $33.11	Professional	26	$12.59	$16.60	$33.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $52.48 / $114.82	Professional	TC	$36.31	$52.48	$114.82