Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.84 / $7.36 / $39.68	Facility	26	$5.84	$7.36	$39.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.51 / $158.77 / $428.49	Facility	TC	$30.51	$158.77	$428.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.08 / $46.24 / $175.00	Professional		$27.08	$46.24	$175.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.84 / $9.65 / $35.97	Professional	26	$5.84	$9.65	$35.97
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $336.00 / $336.00 / $336.00	Professional	50	$336.00	$336.00	$336.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.54 / $17.94 / $102.92	Professional	52	$13.54	$17.94	$102.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $32.72 / $92.48	Professional	TC	$22.57	$32.72	$92.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.26 / $50.65 / $95.16	Professional		$32.26	$50.65	$95.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $4.90 / $8.16 / $12.28	Professional	26	$4.90	$8.16	$12.28
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $121.23 / $121.23 / $121.23	Professional	50	$121.23	$121.23	$121.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $46.50 / $57.88 / $57.88	Professional	TC	$46.50	$57.88	$57.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.41 / $36.79 / $75.76	Professional		$26.41	$36.79	$75.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.85 / $8.89 / $17.11	Professional	26	$6.85	$8.89	$17.11
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $34.26 / $48.79 / $73.65	Professional	50	$34.26	$48.79	$73.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.12 / $28.08 / $58.65	Professional	TC	$20.12	$28.08	$58.65
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $31.19 / $39.34 / $95.53	Professional		$31.19	$39.34	$95.53
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $8.19 / $18.91	Professional	26	$6.46	$8.19	$18.91
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.59 / $30.98 / $74.23	Professional	TC	$24.59	$30.98	$74.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.66 / $7.66 / $7.66	Facility	26	$7.66	$7.66	$7.66
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Facility	TC	$35.40	$35.40	$35.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.50 / $40.42 / $94.16	Professional		$26.50	$40.42	$94.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.87 / $8.33 / $18.68	Professional	26	$5.87	$8.33	$18.68
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $43.71 / $43.71 / $49.70	Professional	50	$43.71	$43.71	$49.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.63 / $31.87 / $81.73	Professional	TC	$20.63	$31.87	$81.73
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $15.59 / $50.76 / $68.53	Professional		$15.59	$50.76	$68.53
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $3.27 / $7.47 / $10.08	Professional	26	$3.27	$7.47	$10.08
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.32 / $43.29 / $58.44	Professional	TC	$12.32	$43.29	$58.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $36.93 / $49.97 / $79.95	Professional		$36.93	$49.97	$79.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $6.57 / $8.96 / $14.19	Professional	26	$6.57	$8.96	$14.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.63 / $50.12 / $81.26	Professional	TC	$34.63	$50.12	$81.26
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.63 / $100.00 / $100.00	Facility	26	$19.63	$100.00	$100.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $173.52 / $173.52	Facility	TC	$100.00	$173.52	$173.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $241.48 / $241.48 / $324.52	Professional		$241.48	$241.48	$324.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.19 / $51.19 / $54.60	Professional	26	$51.19	$51.19	$54.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.06 / $199.06 / $269.93	Professional	TC	$199.06	$199.06	$269.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $34.59	Professional		$32.34	$32.34	$34.59
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $7.66 / $7.66 / $7.66	Facility	26	$7.66	$7.66	$7.66
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Facility	TC	$35.40	$35.40	$35.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $28.32 / $48.38 / $100.63	Professional		$28.32	$48.38	$100.63
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $5.88 / $8.23 / $18.27	Professional	26	$5.88	$8.23	$18.27
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $41.04 / $41.04 / $43.37	Professional	52	$41.04	$41.04	$43.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.63 / $30.92 / $73.88	Professional	TC	$20.63	$30.92	$73.88
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $118.45 / $118.45 / $118.45	Professional		$118.45	$118.45	$118.45
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $22.83 / $22.83 / $22.83	Professional	26	$22.83	$22.83	$22.83
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $95.61 / $95.61 / $95.61	Professional	TC	$95.61	$95.61	$95.61
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $23.38 / $41.05 / $56.44	Professional		$23.38	$41.05	$56.44
United Facility/Professional Professional Modifier Low / Median / High Price $21.85 / $36.09 / $90.89	Professional		$21.85	$36.09	$90.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.26 / $7.22 / $17.68	Professional	26	$5.26	$7.22	$17.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.59 / $28.87 / $87.10	Professional	TC	$16.59	$28.87	$87.10