Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $24.55 / $79.43	Facility	26	$12.02	$24.55	$79.43
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $46.77 / $114.82 / $194.98	Facility	TC	$46.77	$114.82	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $52.48 / $223.87	Professional		$34.67	$52.48	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.38 / $57.54	Professional	26	$10.96	$17.38	$57.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $31.62 / $114.82	Professional	TC	$22.91	$31.62	$114.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $33.88 / $97.72	Professional		$31.62	$33.88	$97.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $15.85 / $29.51	Professional	26	$12.02	$15.85	$29.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $77.62 / $131.83	Professional		$51.29	$77.62	$131.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $25.12 / $41.69	Professional	26	$16.60	$25.12	$41.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $51.29 / $87.10	Professional	TC	$34.67	$51.29	$87.10
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $58.88 / $117.49	Professional		$41.69	$58.88	$117.49
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $19.95 / $37.15	Professional	26	$14.13	$19.95	$37.15
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $38.90 / $79.43	Professional	TC	$27.54	$38.90	$79.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.09 / $14.45 / $20.89	Facility	26	$3.09	$14.45	$20.89
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.92 / $32.36 / $46.77	Facility	TC	$6.92	$32.36	$46.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $52.48 / $97.72	Professional		$35.48	$52.48	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $17.38 / $33.11	Professional	26	$11.22	$17.38	$33.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $35.48 / $70.79	Professional	TC	$23.99	$35.48	$70.79
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $56.23 / $75.86	Professional		$37.15	$56.23	$75.86
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $14.45 / $19.50	Professional	26	$12.30	$14.45	$19.50
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $41.69 / $56.23	Professional	TC	$25.12	$41.69	$56.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $52.48 / $91.20	Professional		$40.74	$52.48	$91.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $16.60 / $26.92	Professional	26	$12.30	$16.60	$26.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $44.67 / $77.62	Professional	TC	$34.67	$44.67	$77.62
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $81.28 / $81.28	Facility	26	$81.28	$81.28	$81.28
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $194.98 / $194.98 / $194.98	Facility	TC	$194.98	$194.98	$194.98
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $354.81 / $354.81	Professional		$275.42	$354.81	$354.81
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $102.33 / $102.33	Professional	26	$81.28	$102.33	$102.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $257.04 / $257.04	Professional	TC	$194.98	$257.04	$257.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $33.11 / $48.98	Professional		$15.14	$33.11	$48.98
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.09 / $14.45 / $20.89	Facility	26	$3.09	$14.45	$20.89
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $6.92 / $32.36 / $46.77	Facility	TC	$6.92	$32.36	$46.77
Providence Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $54.95 / $109.65	Professional		$35.48	$54.95	$109.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $16.22 / $30.90	Professional	26	$11.22	$16.22	$30.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.88 / $69.18	Professional	TC	$23.44	$33.88	$69.18
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $138.04	Professional		$138.04	$138.04	$138.04
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	26	$43.65	$43.65	$43.65
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	TC	$95.50	$95.50	$95.50
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $51.29 / $63.10	Professional		$37.15	$51.29	$63.10
United Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $42.66 / $89.13	Professional		$31.62	$42.66	$89.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $13.80 / $27.54	Professional	26	$10.72	$13.80	$27.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $28.18 / $61.66	Professional	TC	$19.95	$28.18	$61.66