Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.15 / $10.53 / $55.63	Facility	26	$10.15	$10.53	$55.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.35 / $40.06 / $180.32	Professional		$27.35	$40.06	$180.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.38 / $10.48 / $40.49	Professional	26	$8.38	$10.48	$40.49
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.18 / $16.45 / $78.65	Professional	52	$12.18	$16.45	$78.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.23 / $28.39 / $114.90	Professional	TC	$18.23	$28.39	$114.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $51.15 / $51.15 / $51.15	Professional		$51.15	$51.15	$51.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.45 / $9.27 / $20.20	Professional	26	$7.45	$9.27	$20.20
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $19.01 / $20.41 / $20.41	Professional	52	$19.01	$20.41	$20.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.24 / $46.10 / $90.05	Professional		$33.24	$46.10	$90.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.39 / $13.49 / $26.67	Professional	26	$10.39	$13.49	$26.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.37 / $32.56 / $63.28	Professional	TC	$22.37	$32.56	$63.28
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $34.04 / $43.81 / $100.00	Professional		$34.04	$43.81	$100.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.71 / $12.41 / $28.62	Professional	26	$9.71	$12.41	$28.62
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $25.14 / $32.11 / $79.95	Professional	TC	$25.14	$32.11	$79.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.95 / $46.03 / $86.87	Professional		$28.95	$46.03	$86.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.63 / $12.47 / $26.43	Professional	26	$8.63	$12.47	$26.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.58 / $33.46 / $64.56	Professional	TC	$20.58	$33.46	$64.56
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $25.90 / $37.38 / $50.46	Professional		$25.90	$37.38	$50.46
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.25 / $10.15 / $13.70	Professional	26	$7.25	$10.15	$13.70
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.64 / $27.22 / $36.75	Professional	TC	$18.64	$27.22	$36.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.53 / $37.25 / $62.88	Professional		$27.53	$37.25	$62.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.18 / $19.27	Professional	26	$8.91	$12.18	$19.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.78 / $31.56 / $51.15	Professional	TC	$21.78	$31.56	$51.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $24.54 / $100.00 / $100.00	Facility	26	$24.54	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $216.00 / $216.00 / $244.05	Professional		$216.00	$216.00	$244.05
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.26 / $79.26 / $79.26	Professional	26	$79.26	$79.26	$79.26
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $170.93 / $205.00 / $205.00	Professional	TC	$170.93	$205.00	$205.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.75 / $32.34 / $32.34	Professional		$21.75	$32.34	$32.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $29.16 / $49.45 / $85.12	Professional		$29.16	$49.45	$85.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.69 / $12.16 / $25.47	Professional	26	$8.69	$12.16	$25.47
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $32.90 / $32.90 / $32.90	Professional	52	$32.90	$32.90	$32.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.58 / $33.46 / $64.48	Professional	TC	$20.58	$33.46	$64.48
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $103.77 / $103.77 / $103.77	Professional		$103.77	$103.77	$103.77
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $30.99 / $30.99 / $30.99	Professional	26	$30.99	$30.99	$30.99
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $72.77 / $72.77 / $72.77	Professional	TC	$72.77	$72.77	$72.77
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $30.22 / $41.56 / $73.87	Professional		$30.22	$41.56	$73.87
United Facility/Professional Professional Modifier Low / Median / High Price $27.28 / $37.84 / $86.96	Professional		$27.28	$37.84	$86.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.08 / $11.24 / $27.93	Professional	26	$8.08	$11.24	$27.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $26.23 / $63.50	Professional	TC	$19.89	$26.23	$63.50