Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $14.45 / $30.20	Facility	26	$10.00	$14.45	$30.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $60.26 / $234.42	Professional		$34.67	$60.26	$234.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.45 / $53.70	Professional	26	$8.91	$14.45	$53.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $43.65 / $165.96	Professional	TC	$25.12	$43.65	$165.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $60.26 / $97.72	Professional		$29.51	$60.26	$97.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $19.50 / $25.70	Professional	26	$10.00	$19.50	$25.70
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $63.10 / $72.44	Professional	TC	$63.10	$63.10	$72.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $64.57 / $117.49	Professional		$45.71	$64.57	$117.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $15.85 / $30.90	Professional	26	$11.75	$15.85	$30.90
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $48.98 / $89.13	Professional	TC	$35.48	$48.98	$89.13
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $66.07 / $128.82	Professional		$45.71	$66.07	$128.82
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $16.22 / $29.51	Professional	26	$12.30	$16.22	$29.51
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $48.98 / $102.33	Professional	TC	$33.11	$48.98	$102.33
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 $36.31 / $57.54 / $102.33	Professional		$36.31	$57.54	$102.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $14.13 / $27.54	Professional	26	$9.55	$14.13	$27.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $43.65 / $81.28	Professional	TC	$26.30	$43.65	$81.28
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $56.23 / $75.86	Professional		$34.67	$56.23	$75.86
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $12.59 / $16.98	Professional	26	$9.33	$12.59	$16.98
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $43.65 / $58.88	Professional	TC	$25.12	$43.65	$58.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $53.70 / $95.50	Professional		$40.74	$53.70	$95.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $14.45 / $23.44	Professional	26	$10.72	$14.45	$23.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $46.77 / $83.18	Professional	TC	$36.31	$46.77	$83.18
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 $263.03 / $338.84 / $338.84	Professional		$263.03	$338.84	$338.84
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $117.49 / $117.49	Professional	26	$117.49	$117.49	$117.49
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $257.04 / $257.04	Professional	TC	$208.93	$257.04	$257.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.59 / $33.11 / $45.71	Professional		$12.59	$33.11	$45.71
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 $36.31 / $60.26 / $104.71	Professional		$36.31	$60.26	$104.71
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $13.49 / $26.30	Professional	26	$9.55	$13.49	$26.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $42.66 / $75.86	Professional	TC	$25.70	$42.66	$75.86
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $131.83 / $131.83	Professional		$131.83	$131.83	$131.83
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $37.15 / $37.15	Professional	26	$37.15	$37.15	$37.15
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	TC	$95.50	$95.50	$95.50
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $63.10 / $85.11	Professional		$45.71	$63.10	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $42.66 / $89.13	Professional		$36.31	$42.66	$89.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $11.48 / $23.44	Professional	26	$8.32	$11.48	$23.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $30.20 / $64.57	Professional	TC	$26.92	$30.20	$64.57