Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.02 / $15.76 / $93.38	Facility	26	$15.02	$15.76	$93.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.49 / $66.33 / $275.00	Professional		$51.49	$66.33	$275.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.70 / $16.00 / $63.30	Professional	26	$13.70	$16.00	$63.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.11 / $43.09 / $110.78	Professional	TC	$37.11	$43.09	$110.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $51.15 / $81.61 / $165.77	Professional		$51.15	$81.61	$165.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.09 / $13.98 / $34.01	Professional	26	$11.09	$13.98	$34.01
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $55.54 / $55.54 / $55.54	Professional	TC	$55.54	$55.54	$55.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.04 / $105.13 / $189.66	Professional		$58.04	$105.13	$189.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.09 / $27.85 / $50.02	Professional	26	$16.09	$27.85	$50.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.15 / $78.31 / $140.44	Professional	TC	$44.15	$78.31	$140.44
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $52.25 / $68.70 / $160.51	Professional		$52.25	$68.70	$160.51
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $5.67 / $7.14 / $22.53	Professional	26	$5.67	$7.14	$22.53
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $46.82 / $61.56 / $141.09	Professional	TC	$46.82	$61.56	$141.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.57 / $75.51 / $162.55	Professional		$51.57	$75.51	$162.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.51 / $20.11 / $43.04	Professional	26	$13.51	$20.11	$43.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.45 / $56.09 / $127.80	Professional	TC	$37.45	$56.09	$127.80
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $51.04 / $81.11 / $109.50	Professional		$51.04	$81.11	$109.50
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.78 / $16.71 / $22.56	Professional	26	$13.78	$16.71	$22.56
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.26 / $64.40 / $86.94	Professional	TC	$37.26	$64.40	$86.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $59.35 / $80.29 / $136.00	Professional		$59.35	$80.29	$136.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.77 / $20.05 / $31.72	Professional	26	$14.77	$20.05	$31.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.52 / $74.52 / $120.82	Professional	TC	$51.52	$74.52	$120.82
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $56.31 / $73.77 / $73.77	Facility	26	$56.31	$73.77	$73.77
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $395.03 / $395.03 / $522.08	Professional		$395.03	$395.03	$522.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.99 / $93.99 / $122.10	Professional	26	$93.99	$93.99	$122.10
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $301.02 / $301.02 / $400.05	Professional	TC	$301.02	$301.02	$400.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $51.82	Professional		$32.34	$32.34	$51.82
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Providence Facility/Professional Professional Modifier Low / Median / High Price $51.83 / $84.81 / $165.54	Professional		$51.83	$84.81	$165.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.51 / $19.72 / $42.75	Professional	26	$13.51	$19.72	$42.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.45 / $55.19 / $123.24	Professional	TC	$37.45	$55.19	$123.24
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $196.89 / $196.89 / $196.89	Professional		$196.89	$196.89	$196.89
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $51.98 / $51.98 / $51.98	Professional	26	$51.98	$51.98	$51.98
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $144.90 / $144.90 / $144.90	Professional	TC	$144.90	$144.90	$144.90
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $65.59 / $73.79 / $90.19	Professional		$65.59	$73.79	$90.19
United Facility/Professional Professional Modifier Low / Median / High Price $45.19 / $63.27 / $151.01	Professional		$45.19	$63.27	$151.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.07 / $17.32 / $40.15	Professional	26	$13.07	$17.32	$40.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.11 / $46.86 / $126.46	Professional	TC	$32.11	$46.86	$126.46