Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $17.78 / $38.90	Facility	26	$14.13	$17.78	$38.90
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.74 / $151.36 / $436.52	Facility	TC	$40.74	$151.36	$436.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $74.13 / $223.87	Professional		$44.67	$74.13	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $19.95 / $54.95	Professional	26	$12.88	$19.95	$54.95
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $75.86 / $100.00 / $269.15	Professional	50	$75.86	$100.00	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $48.98 / $173.78	Professional	TC	$30.90	$48.98	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $60.26 / $125.89	Professional		$42.66	$60.26	$125.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $23.44 / $32.36	Professional	26	$13.49	$23.44	$32.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $72.44 / $93.33	Professional	TC	$30.90	$72.44	$93.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $100.00 / $169.82	Professional		$60.26	$100.00	$169.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $28.84 / $46.77	Professional	26	$18.62	$28.84	$46.77
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $66.07 / $77.62 / $114.82	Professional	50	$66.07	$77.62	$114.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $72.44 / $123.03	Professional	TC	$46.77	$72.44	$123.03
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $74.13 / $147.91	Professional		$52.48	$74.13	$147.91
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $8.51 / $22.39	Professional	26	$6.03	$8.51	$22.39
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $66.07 / $123.03	Professional	TC	$45.71	$66.07	$123.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.47 / $15.85 / $22.91	Facility	26	$3.47	$15.85	$22.91
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $9.33 / $43.65 / $61.66	Facility	TC	$9.33	$43.65	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $64.57 / $123.03	Professional		$44.67	$64.57	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $19.05 / $36.31	Professional	26	$12.59	$19.05	$36.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $46.77 / $93.33	Professional	TC	$30.90	$46.77	$93.33
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $72.44 / $97.72	Professional		$43.65	$72.44	$97.72
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $16.22 / $21.88	Professional	26	$12.59	$16.22	$21.88
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $56.23 / $75.86	Professional	TC	$30.90	$56.23	$75.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $69.18 / $117.49	Professional		$53.70	$69.18	$117.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $18.62 / $30.20	Professional	26	$14.13	$18.62	$30.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $60.26 / $107.15	Professional	TC	$46.77	$60.26	$107.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Facility	26	$89.13	$89.13	$89.13
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $257.04 / $257.04 / $257.04	Facility	TC	$257.04	$257.04	$257.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $457.09 / $457.09	Professional		$346.74	$457.09	$457.09
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $112.20 / $112.20	Professional	26	$89.13	$112.20	$112.20
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $338.84 / $338.84	Professional	TC	$257.04	$338.84	$338.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $33.11 / $60.26	Professional		$16.60	$33.11	$60.26
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.47 / $15.85 / $22.91	Facility	26	$3.47	$15.85	$22.91
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $9.33 / $43.65 / $61.66	Facility	TC	$9.33	$43.65	$61.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $67.61 / $134.90	Professional		$44.67	$67.61	$134.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $17.78 / $34.67	Professional	26	$12.59	$17.78	$34.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $44.67 / $91.20	Professional	TC	$30.90	$44.67	$91.20
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $173.78	Professional		$173.78	$173.78	$173.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $48.98 / $48.98	Professional	26	$48.98	$48.98	$48.98
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $125.89 / $125.89	Professional	TC	$125.89	$125.89	$125.89
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $61.66 / $79.43	Professional		$43.65	$61.66	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $52.48 / $112.20	Professional		$38.90	$52.48	$112.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $15.14 / $30.90	Professional	26	$12.02	$15.14	$30.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $37.15 / $83.18	Professional	TC	$26.92	$37.15	$83.18