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 / $57.54	Facility	26	$10.00	$14.45	$57.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $45.71 / $181.97	Professional		$25.70	$45.71	$181.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.49 / $44.67	Professional	26	$7.94	$13.49	$44.67
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $54.95 / $158.49	Professional	52	$30.20	$54.95	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $30.20 / $123.03	Professional	TC	$15.85	$30.20	$123.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $40.74 / $63.10	Professional		$27.54	$40.74	$63.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $15.85 / $15.85	Professional	26	$15.85	$15.85	$15.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $50.12 / $91.20	Professional		$35.48	$50.12	$91.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $14.13 / $26.30	Professional	26	$10.72	$14.13	$26.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $35.48 / $64.57	Professional	TC	$25.12	$35.48	$64.57
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $54.95 / $97.72	Professional		$39.81	$54.95	$97.72
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $15.14 / $26.92	Professional	26	$11.75	$15.14	$26.92
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $39.81 / $70.79	Professional	TC	$28.18	$39.81	$70.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.19 / $10.23 / $14.79	Facility	26	$2.19	$10.23	$14.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $44.67 / $81.28	Professional		$27.54	$44.67	$81.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $12.59 / $23.99	Professional	26	$8.32	$12.59	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $33.11 / $60.26	Professional	TC	$19.95	$33.11	$60.26
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $40.74 / $54.95	Professional		$25.70	$40.74	$54.95
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $10.96 / $14.79	Professional	26	$7.24	$10.96	$14.79
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $29.51 / $39.81	Professional	TC	$18.62	$29.51	$39.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $38.02 / $70.79	Professional		$29.51	$38.02	$70.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $12.59 / $20.42	Professional	26	$9.55	$12.59	$20.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $31.62 / $54.95	Professional	TC	$23.99	$31.62	$54.95
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 $213.80 / $245.47 / $245.47	Professional		$213.80	$245.47	$245.47
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $79.43 / $79.43	Professional	26	$79.43	$79.43	$79.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $169.82 / $204.17	Professional	TC	$169.82	$169.82	$204.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $32.36 / $33.11	Professional		$10.72	$32.36	$33.11
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.19 / $10.23 / $14.79	Facility	26	$2.19	$10.23	$14.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $46.77 / $77.62	Professional		$28.18	$46.77	$77.62
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $12.02 / $22.91	Professional	26	$8.13	$12.02	$22.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $32.36 / $57.54	Professional	TC	$19.05	$32.36	$57.54
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Professional		$104.71	$104.71	$104.71
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $30.90 / $30.90	Professional	26	$30.90	$30.90	$30.90
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $72.44 / $72.44	Professional	TC	$72.44	$72.44	$72.44
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $45.71 / $74.13	Professional		$33.11	$45.71	$74.13
United Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $35.48 / $69.18	Professional		$26.92	$35.48	$69.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.23 / $19.95	Professional	26	$7.41	$10.23	$19.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $24.55 / $48.98	Professional	TC	$18.62	$24.55	$48.98