Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $13.49 / $30.90	Facility	26	$10.00	$13.49	$30.90
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.74 / $169.82 / $588.84	Facility	TC	$40.74	$169.82	$588.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $60.26 / $218.78	Professional		$25.12	$60.26	$218.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $21.38 / $66.07	Professional	26	$10.23	$21.38	$66.07
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $56.23 / $123.03 / $302.00	Professional	50	$56.23	$123.03	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $53.70 / $162.18	Professional	TC	$28.18	$53.70	$162.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $51.29 / $104.71	Professional		$35.48	$51.29	$104.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $19.05 / $26.30	Professional	26	$10.23	$19.05	$26.30
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $51.29 / $60.26 / $117.49	Professional	50	$51.29	$60.26	$117.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $58.88 / $87.10	Professional	TC	$30.90	$58.88	$87.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $54.95 / $112.20	Professional		$40.74	$54.95	$112.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $16.22 / $31.62	Professional	26	$11.75	$16.22	$31.62
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $52.48 / $66.07 / $102.33	Professional	50	$52.48	$66.07	$102.33
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.02 / $81.28	Professional	TC	$28.84	$38.02	$81.28
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $60.26 / $120.23	Professional		$43.65	$60.26	$120.23
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $16.22 / $29.51	Professional	26	$12.30	$16.22	$29.51
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $44.67 / $91.20	Professional	TC	$31.62	$44.67	$91.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.69 / $12.59 / $17.78	Facility	26	$2.69	$12.59	$17.78
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	TC	$8.51	$39.81	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $53.70 / $107.15	Professional		$36.31	$53.70	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $14.13 / $28.18	Professional	26	$9.77	$14.13	$28.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $38.90 / $81.28	Professional	TC	$25.70	$38.90	$81.28
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $66.07 / $91.20	Professional		$27.54	$66.07	$91.20
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $12.88 / $17.38	Professional	26	$7.41	$12.88	$17.38
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $53.70 / $72.44	Professional	TC	$20.42	$53.70	$72.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $63.10 / $107.15	Professional		$48.98	$63.10	$107.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $14.79 / $24.55	Professional	26	$11.22	$14.79	$24.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $57.54 / $102.33	Professional	TC	$44.67	$57.54	$102.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	TC	$229.09	$229.09	$229.09
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $398.11 / $398.11	Professional		$66.07	$398.11	$398.11
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $89.13 / $89.13	Professional	26	$87.10	$89.13	$89.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $309.03 / $309.03	Professional	TC	$229.09	$309.03	$309.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.18 / $33.11 / $52.48	Professional		$13.18	$33.11	$52.48
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.69 / $12.59 / $17.78	Facility	26	$2.69	$12.59	$17.78
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	TC	$8.51	$39.81	$56.23
Providence Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $56.23 / $114.82	Professional		$36.31	$56.23	$114.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $13.49 / $26.30	Professional	26	$9.55	$13.49	$26.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $37.15 / $79.43	Professional	TC	$25.70	$37.15	$79.43
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $144.54 / $144.54	Professional		$144.54	$144.54	$144.54
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $37.15 / $37.15	Professional	26	$37.15	$37.15	$37.15
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	TC	$109.65	$109.65	$109.65
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $56.23 / $70.79	Professional		$41.69	$56.23	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $44.67 / $95.50	Professional		$30.20	$44.67	$95.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $11.48 / $23.44	Professional	26	$8.51	$11.48	$23.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $33.11 / $72.44	Professional	TC	$20.89	$33.11	$72.44