Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.85 / $8.25 / $49.25	Facility	26	$7.85	$8.25	$49.25
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.26 / $84.09 / $247.68	Facility	TC	$22.26	$84.09	$247.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.85 / $28.51 / $130.00	Professional		$24.85	$28.51	$130.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.15 / $8.25 / $33.00	Professional	26	$7.15	$8.25	$33.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.84 / $19.45 / $52.81	Professional	TC	$16.84	$19.45	$52.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.55 / $18.55 / $22.17	Professional		$18.55	$18.55	$22.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.63 / $7.61 / $26.86	Professional	26	$6.63	$7.61	$26.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.95 / $51.60 / $91.56	Professional		$27.95	$51.60	$91.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.44 / $14.56 / $26.14	Professional	26	$8.44	$14.56	$26.14
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.21 / $37.18 / $66.80	Professional	TC	$20.21	$37.18	$66.80
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $25.91 / $33.50 / $89.25	Professional		$25.91	$33.50	$89.25
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $3.11 / $3.91 / $12.16	Professional	26	$3.11	$3.91	$12.16
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $22.48 / $29.59 / $72.26	Professional	TC	$22.48	$29.59	$72.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $24.18 / $24.18 / $24.18	Facility	TC	$24.18	$24.18	$24.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.24 / $36.94 / $79.95	Professional		$25.24	$36.94	$79.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.06 / $10.60 / $22.55	Professional	26	$7.06	$10.60	$22.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.86 / $26.51 / $59.10	Professional	TC	$17.86	$26.51	$59.10
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $24.94 / $38.51 / $51.99	Professional		$24.94	$38.51	$51.99
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.23 / $8.99 / $12.14	Professional	26	$7.23	$8.99	$12.14
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.71 / $29.52 / $39.85	Professional	TC	$17.71	$29.52	$39.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $29.03 / $38.25 / $64.52	Professional		$29.03	$38.25	$64.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.90 / $10.79 / $17.07	Professional	26	$7.90	$10.79	$17.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.62 / $34.22 / $55.45	Professional	TC	$23.62	$34.22	$55.45
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 $64.78 / $118.47 / $118.47	Facility	TC	$64.78	$118.47	$118.47
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $187.12 / $187.12 / $250.20	Professional		$187.12	$187.12	$250.20
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.02 / $51.02 / $65.18	Professional	26	$51.02	$51.02	$65.18
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $136.11 / $136.11 / $185.03	Professional	TC	$136.11	$136.11	$185.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.64 / $32.34 / $32.34	Professional		$19.64	$32.34	$32.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $24.18 / $24.18 / $24.18	Facility	TC	$24.18	$24.18	$24.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $26.96 / $41.46 / $80.81	Professional		$26.96	$41.46	$80.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.13 / $10.42 / $22.48	Professional	26	$7.13	$10.42	$22.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $17.86 / $25.98 / $58.65	Professional	TC	$17.86	$25.98	$58.65
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $96.66 / $96.66 / $96.66	Professional		$96.66	$96.66	$96.66
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $27.49 / $27.49 / $27.49	Professional	26	$27.49	$27.49	$27.49
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $69.16 / $69.16 / $69.16	Professional	TC	$69.16	$69.16	$69.16
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $31.14 / $35.03 / $42.81	Professional		$31.14	$35.03	$42.81
United Facility/Professional Professional Modifier Low / Median / High Price $22.17 / $31.04 / $81.05	Professional		$22.17	$31.04	$81.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.82 / $9.27 / $25.98	Professional	26	$6.82	$9.27	$25.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.35 / $22.63 / $63.29	Professional	TC	$15.35	$22.63	$63.29