Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.82 / $12.37 / $67.88	Facility	26	$10.82	$12.37	$67.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.17 / $125.70 / $533.19	Facility	TC	$24.17	$125.70	$533.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.19 / $43.60 / $182.60	Professional		$30.19	$43.60	$182.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.31 / $17.00 / $58.49	Professional	26	$10.31	$17.00	$58.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $24.85 / $95.39	Professional	TC	$19.89	$24.85	$95.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.17 / $52.18 / $99.16	Professional		$26.17	$52.18	$99.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.18 / $12.60 / $20.34	Professional	26	$8.18	$12.60	$20.34
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $31.07 / $31.07 / $31.07	Professional	TC	$31.07	$31.07	$31.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.70 / $59.48 / $112.07	Professional		$31.70	$59.48	$112.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.21 / $19.84 / $36.04	Professional	26	$11.21	$19.84	$36.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.17 / $39.79 / $75.28	Professional	TC	$20.17	$39.79	$75.28
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $30.72 / $40.26 / $100.00	Professional		$30.72	$40.26	$100.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.69 / $13.34 / $33.49	Professional	26	$9.69	$13.34	$33.49
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $20.57 / $26.95 / $64.98	Professional	TC	$20.57	$26.95	$64.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.36 / $12.36 / $12.36	Facility	26	$12.36	$12.36	$12.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.32 / $45.48 / $100.82	Professional		$30.32	$45.48	$100.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.75 / $14.68 / $31.08	Professional	26	$9.75	$14.68	$31.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.46 / $30.60 / $71.94	Professional	TC	$20.46	$30.60	$71.94
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $30.06 / $47.86 / $64.61	Professional		$30.06	$47.86	$64.61
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.92 / $12.37 / $16.70	Professional	26	$9.92	$12.37	$16.70
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.14 / $35.49 / $47.91	Professional	TC	$20.14	$35.49	$47.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $36.19 / $47.62 / $79.09	Professional		$36.19	$47.62	$79.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.91 / $14.84 / $23.50	Professional	26	$10.91	$14.84	$23.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.39 / $41.10 / $66.63	Professional	TC	$28.39	$41.10	$66.63
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $26.10 / $70.00 / $70.00	Facility	26	$26.10	$70.00	$70.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $50.86 / $142.31 / $142.31	Facility	TC	$50.86	$142.31	$142.31
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $236.84 / $236.84 / $310.73	Professional		$236.84	$236.84	$310.73
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.37 / $70.37 / $88.88	Professional	26	$70.37	$70.37	$88.88
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $166.53 / $166.53 / $221.85	Professional	TC	$166.53	$166.53	$221.85
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.72 / $32.34 / $32.34	Professional		$28.72	$32.34	$32.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.36 / $12.36 / $12.36	Facility	26	$12.36	$12.36	$12.36
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $33.18 / $51.64 / $99.59	Professional		$33.18	$51.64	$99.59
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.81 / $14.59 / $31.02	Professional	26	$9.81	$14.59	$31.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.87 / $30.49 / $68.64	Professional	TC	$20.87	$30.49	$68.64
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $119.15 / $119.15 / $119.15	Professional		$119.15	$119.15	$119.15
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $37.96 / $37.96 / $37.96	Professional	26	$37.96	$37.96	$37.96
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $81.19 / $81.19 / $81.19	Professional	TC	$81.19	$81.19	$81.19
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $38.70 / $43.53 / $53.21	Professional		$38.70	$43.53	$53.21
United Facility/Professional Professional Modifier Low / Median / High Price $26.71 / $37.61 / $99.76	Professional		$26.71	$37.61	$99.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.38 / $12.27 / $29.42	Professional	26	$9.38	$12.27	$29.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.32 / $25.76 / $73.95	Professional	TC	$17.32	$25.76	$73.95