Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $18.62 / $45.71	Facility	26	$14.13	$18.62	$45.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $75.86 / $239.88	Professional		$50.12	$75.86	$239.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $21.38 / $63.10	Professional	26	$12.02	$21.38	$63.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $51.29 / $144.54	Professional	TC	$33.88	$51.29	$144.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $53.70 / $114.82	Professional		$35.48	$53.70	$114.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $20.89 / $30.20	Professional	26	$12.02	$20.89	$30.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $50.12 / $79.43	Professional	TC	$30.90	$50.12	$79.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $75.86 / $144.54	Professional		$54.95	$75.86	$144.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $21.88 / $38.90	Professional	26	$16.22	$21.88	$38.90
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $53.70 / $102.33	Professional	TC	$39.81	$53.70	$102.33
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $77.62 / $147.91	Professional		$54.95	$77.62	$147.91
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $21.88 / $38.02	Professional	26	$16.98	$21.88	$38.02
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $54.95 / $112.20	Professional	TC	$37.15	$54.95	$112.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.09 / $14.45 / $20.89	Facility	26	$3.09	$14.45	$20.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $67.61 / $125.89	Professional		$44.67	$67.61	$125.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $18.62 / $34.67	Professional	26	$11.48	$18.62	$34.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $48.98 / $93.33	Professional	TC	$30.90	$48.98	$93.33
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $72.44 / $97.72	Professional		$43.65	$72.44	$97.72
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $14.45 / $19.50	Professional	26	$13.49	$14.45	$19.50
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $57.54 / $77.62	Professional	TC	$30.20	$57.54	$77.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $67.61 / $120.23	Professional		$52.48	$67.61	$120.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $16.98 / $27.54	Professional	26	$12.59	$16.98	$27.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $61.66 / $107.15	Professional	TC	$46.77	$61.66	$107.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $436.52 / $436.52	Professional		$85.11	$436.52	$436.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $190.55 / $190.55	Professional	26	$120.23	$190.55	$190.55
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $331.13 / $331.13	Professional	TC	$295.12	$331.13	$331.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $33.11 / $57.54	Professional		$15.85	$33.11	$57.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.09 / $14.45 / $20.89	Facility	26	$3.09	$14.45	$20.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $69.18 / $128.82	Professional		$44.67	$69.18	$128.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $17.78 / $32.36	Professional	26	$11.48	$17.78	$32.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $46.77 / $91.20	Professional	TC	$30.20	$46.77	$91.20
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $162.18	Professional		$67.61	$67.61	$162.18
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $42.66 / $42.66	Professional	26	$42.66	$42.66	$42.66
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $117.49 / $117.49	Professional	TC	$117.49	$117.49	$117.49
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $81.28 / $120.23	Professional		$58.88	$81.28	$120.23
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $50.12 / $107.15	Professional		$39.81	$50.12	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $14.45 / $28.18	Professional	26	$10.72	$14.45	$28.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $35.48 / $79.43	Professional	TC	$28.18	$35.48	$79.43