Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.67 / $13.04 / $78.19	Facility	26	$12.67	$13.04	$78.19
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.17 / $104.99 / $205.03	Facility	TC	$28.17	$104.99	$205.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.22 / $42.13 / $212.00	Professional		$35.22	$42.13	$212.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $13.49 / $50.77	Professional	26	$11.55	$13.49	$50.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.17 / $28.17 / $73.30	Professional	TC	$23.17	$28.17	$73.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.51 / $40.51 / $43.00	Professional		$40.51	$40.51	$43.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.44 / $10.16 / $28.89	Professional	26	$9.44	$10.16	$28.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.11 / $69.40 / $128.80	Professional		$37.11	$69.40	$128.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.22 / $23.20 / $41.89	Professional	26	$13.22	$23.20	$41.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.47 / $46.36 / $86.64	Professional	TC	$23.47	$46.36	$86.64
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $35.85 / $46.92 / $109.75	Professional		$35.85	$46.92	$109.75
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.35 / $15.52 / $38.78	Professional	26	$11.35	$15.52	$38.78
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $23.98 / $31.61 / $85.04	Professional	TC	$23.98	$31.61	$85.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $33.92 / $33.92 / $33.92	Facility	TC	$33.92	$33.92	$33.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.43 / $51.99 / $115.72	Professional		$35.43	$51.99	$115.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.41 / $17.13 / $36.32	Professional	26	$11.41	$17.13	$36.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.87 / $35.68 / $82.49	Professional	TC	$23.87	$35.68	$82.49
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $37.40 / $55.23 / $74.56	Professional		$37.40	$55.23	$74.56
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.34 / $14.24 / $19.22	Professional	26	$12.34	$14.24	$19.22
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.06 / $40.99 / $55.34	Professional	TC	$25.06	$40.99	$55.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.61 / $54.95 / $91.26	Professional		$40.61	$54.95	$91.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.57 / $17.09 / $27.03	Professional	26	$12.57	$17.09	$27.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $47.48 / $76.95	Professional	TC	$32.79	$47.48	$76.95
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $30.22 / $70.00 / $70.00	Facility	26	$30.22	$70.00	$70.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $58.74 / $164.35 / $164.35	Facility	TC	$58.74	$164.35	$164.35
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $277.95 / $277.95 / $357.83	Professional		$277.95	$277.95	$357.83
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.06 / $81.06 / $102.08	Professional	26	$81.06	$81.06	$102.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $196.89 / $196.89 / $255.75	Professional	TC	$196.89	$196.89	$255.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $33.49	Professional		$32.34	$32.34	$33.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $33.92 / $33.92 / $33.92	Facility	TC	$33.92	$33.92	$33.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $37.13 / $58.94 / $115.91	Professional		$37.13	$58.94	$115.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.41 / $16.93 / $36.01	Professional	26	$11.41	$16.93	$36.01
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.26 / $35.52 / $80.01	Professional	TC	$24.26	$35.52	$80.01
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $138.18 / $138.18 / $138.18	Professional		$138.18	$138.18	$138.18
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $43.77 / $43.77 / $43.77	Professional	26	$43.77	$43.77	$43.77
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $94.41 / $94.41 / $94.41	Professional	TC	$94.41	$94.41	$94.41
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $44.66 / $52.36 / $63.58	Professional		$44.66	$52.36	$63.58
United Facility/Professional Professional Modifier Low / Median / High Price $31.27 / $44.00 / $115.67	Professional		$31.27	$44.00	$115.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.09 / $14.55 / $34.54	Professional	26	$11.09	$14.55	$34.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.18 / $29.08 / $71.27	Professional	TC	$20.18	$29.08	$71.27