Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.40 / $14.05 / $80.63	Facility	26	$13.40	$14.05	$80.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.93 / $66.38 / $175.00	Professional		$46.93	$66.38	$175.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.18 / $13.40 / $50.22	Professional	26	$12.18	$13.40	$50.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.14 / $40.33 / $99.88	Professional	TC	$34.14	$40.33	$99.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $38.08 / $54.78 / $127.33	Professional		$38.08	$54.78	$127.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.71 / $14.24 / $59.00	Professional	26	$10.71	$14.24	$59.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.88 / $96.92 / $173.79	Professional		$55.88	$96.92	$173.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.33 / $24.77 / $43.33	Professional	26	$14.33	$24.77	$43.33
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $70.06 / $82.43 / $117.22	Professional	50	$70.06	$82.43	$117.22
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.52 / $72.53 / $130.24	Professional	TC	$43.52	$72.53	$130.24
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $47.68 / $62.67 / $147.56	Professional		$47.68	$62.67	$147.56
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $5.19 / $6.54 / $19.82	Professional	26	$5.19	$6.54	$19.82
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $42.71 / $56.13 / $131.04	Professional	TC	$42.71	$56.13	$131.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.00 / $15.00 / $15.00	Facility	26	$15.00	$15.00	$15.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.77 / $70.87 / $155.99	Professional		$47.77	$70.87	$155.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.03 / $17.76 / $38.29	Professional	26	$12.03	$17.76	$38.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.43 / $52.64 / $123.30	Professional	TC	$35.43	$52.64	$123.30
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $46.57 / $79.70 / $107.60	Professional		$46.57	$79.70	$107.60
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.11 / $14.84 / $20.03	Professional	26	$12.11	$14.84	$20.03
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.46 / $64.86 / $87.56	Professional	TC	$34.46	$64.86	$87.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.20 / $78.73 / $128.04	Professional		$58.20	$78.73	$128.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.11 / $17.80 / $28.16	Professional	26	$13.11	$17.80	$28.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.89 / $75.05 / $121.67	Professional	TC	$51.89	$75.05	$121.67
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $70.00 / $70.00	Facility	26	$50.00	$70.00	$70.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $379.94 / $379.94 / $511.80	Professional		$379.94	$379.94	$511.80
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.23 / $83.23 / $108.90	Professional	26	$83.23	$83.23	$108.90
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $296.70 / $296.70 / $402.90	Professional	TC	$296.70	$296.70	$402.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $51.09	Professional		$32.34	$32.34	$51.09
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.00 / $15.00 / $15.00	Facility	26	$15.00	$15.00	$15.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $51.35 / $79.84 / $158.13	Professional		$51.35	$79.84	$158.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.03 / $17.46 / $36.92	Professional	26	$12.03	$17.46	$36.92
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $51.77 / $117.56	Professional	TC	$36.31	$51.77	$117.56
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $186.27 / $186.27 / $186.27	Professional		$186.27	$186.27	$186.27
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $44.97 / $44.97 / $44.97	Professional	26	$44.97	$44.97	$44.97
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $141.29 / $141.29 / $141.29	Professional	TC	$141.29	$141.29	$141.29
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $60.54 / $72.51 / $88.63	Professional		$60.54	$72.51	$88.63
United Facility/Professional Professional Modifier Low / Median / High Price $41.21 / $62.33 / $171.80	Professional		$41.21	$62.33	$171.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.66 / $14.82 / $39.15	Professional	26	$11.66	$14.82	$39.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.55 / $43.28 / $123.61	Professional	TC	$29.55	$43.28	$123.61