Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.50 / $7.76 / $38.90	Facility	26	$5.50	$7.76	$38.90
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.51 / $114.82 / $316.23	Facility	TC	$29.51	$114.82	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $43.65 / $158.49	Professional		$19.05	$43.65	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.50 / $10.72 / $33.88	Professional	26	$5.50	$10.72	$33.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $33.11 / $112.20	Professional	TC	$19.95	$33.11	$112.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $33.11 / $63.10	Professional		$25.70	$33.11	$63.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.13 / $10.96 / $14.79	Professional	26	$5.13	$10.96	$14.79
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $20.89 / $41.69	Professional	TC	$15.14	$20.89	$41.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $35.48 / $72.44	Professional		$26.30	$35.48	$72.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $9.55 / $17.78	Professional	26	$6.76	$9.55	$17.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $26.30 / $56.23	Professional	TC	$19.95	$26.30	$56.23
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $42.66 / $83.18	Professional		$31.62	$42.66	$83.18
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $9.12 / $16.60	Professional	26	$6.92	$9.12	$16.60
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $33.88 / $67.61	Professional	TC	$24.55	$33.88	$67.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1.55 / $7.24 / $10.47	Facility	26	$1.55	$7.24	$10.47
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $5.25 / $24.55 / $35.48	Facility	TC	$5.25	$24.55	$35.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $36.31 / $70.79	Professional		$23.99	$36.31	$70.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $8.13 / $16.22	Professional	26	$5.62	$8.13	$16.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $27.54 / $57.54	Professional	TC	$18.20	$27.54	$57.54
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $15.49 / $38.90 / $52.48	Professional		$15.49	$38.90	$52.48
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $3.63 / $7.24 / $9.77	Professional	26	$3.63	$7.24	$9.77
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $30.90 / $41.69	Professional	TC	$12.02	$30.90	$41.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $36.31 / $60.26	Professional		$28.18	$36.31	$60.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $8.32 / $13.49	Professional	26	$6.31	$8.32	$13.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $33.88 / $58.88	Professional	TC	$25.70	$33.88	$58.88
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 $147.91 / $147.91 / $147.91	Facility	TC	$147.91	$147.91	$147.91
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $245.47 / $245.47	Professional		$186.21	$245.47	$245.47
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $54.95 / $54.95	Professional	26	$54.95	$54.95	$54.95
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $194.98 / $194.98	Professional	TC	$147.91	$194.98	$194.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $7.59 / $32.36 / $33.11	Professional		$7.59	$32.36	$33.11
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $1.55 / $7.24 / $10.47	Facility	26	$1.55	$7.24	$10.47
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $5.25 / $24.55 / $35.48	Facility	TC	$5.25	$24.55	$35.48
Providence Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $37.15 / $74.13	Professional		$23.99	$37.15	$74.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $7.76 / $15.14	Professional	26	$5.62	$7.76	$15.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $26.30 / $54.95	Professional	TC	$18.20	$26.30	$54.95
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $21.88 / $21.88	Professional	26	$21.88	$21.88	$21.88
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $70.79 / $70.79	Professional	TC	$70.79	$70.79	$70.79
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $32.36 / $39.81	Professional		$23.44	$32.36	$39.81
United Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $28.18 / $60.26	Professional		$19.50	$28.18	$60.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.01 / $6.92 / $13.80	Professional	26	$5.01	$6.92	$13.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $21.88 / $47.86	Professional	TC	$15.14	$21.88	$47.86