Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.03 / $16.29 / $87.00	Facility	26	$14.03	$16.29	$87.00
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $38.96 / $159.46 / $436.28	Facility	TC	$38.96	$159.46	$436.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.27 / $62.58 / $213.45	Professional		$44.27	$62.58	$213.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.15 / $15.66 / $55.77	Professional	26	$13.15	$15.66	$55.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.85 / $38.02 / $136.13	Professional	TC	$30.85	$38.02	$136.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $44.59 / $71.06 / $133.19	Professional		$44.59	$71.06	$133.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.43 / $17.55 / $31.77	Professional	26	$10.43	$17.55	$31.77
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $73.19 / $73.19 / $73.19	Professional	TC	$73.19	$73.19	$73.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.55 / $90.95 / $163.40	Professional		$50.55	$90.95	$163.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.05 / $25.98 / $46.67	Professional	26	$15.05	$25.98	$46.67
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $66.06 / $74.73 / $106.96	Professional	50	$66.06	$74.73	$106.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.53 / $65.52 / $116.72	Professional	TC	$37.53	$65.52	$116.72
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $44.74 / $58.92 / $138.00	Professional		$44.74	$58.92	$138.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $5.36 / $6.73 / $21.29	Professional	26	$5.36	$6.73	$21.29
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $39.63 / $52.19 / $119.89	Professional	TC	$39.63	$52.19	$119.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.14 / $16.14 / $16.14	Facility	26	$16.14	$16.14	$16.14
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $44.74 / $44.74 / $44.74	Facility	TC	$44.74	$44.74	$44.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.33 / $64.89 / $139.81	Professional		$44.33	$64.89	$139.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.61 / $18.82 / $40.18	Professional	26	$12.61	$18.82	$40.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.47 / $47.06 / $107.65	Professional	TC	$31.47	$47.06	$107.65
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $43.85 / $70.62 / $95.34	Professional		$43.85	$70.62	$95.34
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.72 / $15.86 / $21.41	Professional	26	$12.72	$15.86	$21.41
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.13 / $54.76 / $73.93	Professional	TC	$31.13	$54.76	$73.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $52.00 / $69.94 / $116.17	Professional		$52.00	$69.94	$116.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.94 / $19.03 / $30.12	Professional	26	$13.94	$19.03	$30.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $43.81 / $63.38 / $102.76	Professional	TC	$43.81	$63.38	$102.76
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 Facility Modifier TC Low / Median / High Price $85.00 / $219.36 / $219.36	Facility	TC	$85.00	$219.36	$219.36
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $345.18 / $345.18 / $453.53	Professional		$345.18	$345.18	$453.53
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.67 / $89.67 / $112.88	Professional	26	$89.67	$89.67	$112.88
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $255.46 / $255.46 / $340.65	Professional	TC	$255.46	$255.46	$340.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $43.76	Professional		$32.34	$32.34	$43.76
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.14 / $16.14 / $16.14	Facility	26	$16.14	$16.14	$16.14
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $44.74 / $44.74 / $44.74	Facility	TC	$44.74	$44.74	$44.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.95 / $72.92 / $143.76	Professional		$44.95	$72.92	$143.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.61 / $18.32 / $39.83	Professional	26	$12.61	$18.32	$39.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.99 / $46.70 / $104.56	Professional	TC	$31.99	$46.70	$104.56
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $172.94 / $172.94 / $172.94	Professional		$172.94	$172.94	$172.94
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $48.47 / $48.47 / $48.47	Professional	26	$48.47	$48.47	$48.47
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $124.46 / $124.46 / $124.46	Professional	TC	$124.46	$124.46	$124.46
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $57.01 / $64.26 / $78.54	Professional		$57.01	$64.26	$78.54
United Facility/Professional Professional Modifier Low / Median / High Price $38.94 / $52.69 / $175.02	Professional		$38.94	$52.69	$175.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.23 / $16.01 / $36.09	Professional	26	$12.23	$16.01	$36.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.71 / $38.75 / $96.79	Professional	TC	$26.71	$38.75	$96.79