Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.39 / $15.13 / $92.88	Facility	26	$14.39	$15.13	$92.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.64 / $55.86 / $237.94	Professional		$43.64	$55.86	$237.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.58 / $17.61 / $67.38	Professional	26	$13.58	$17.61	$67.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.22 / $35.79 / $85.29	Professional	TC	$29.22	$35.79	$85.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.28 / $53.58 / $88.25	Professional		$41.28	$53.58	$88.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.34 / $14.18 / $29.10	Professional	26	$11.34	$14.18	$29.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.32 / $60.52 / $117.63	Professional		$44.32	$60.52	$117.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.54 / $21.06 / $41.40	Professional	26	$16.54	$21.06	$41.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.71 / $39.44 / $79.00	Professional	TC	$26.71	$39.44	$79.00
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $43.67 / $54.96 / $127.15	Professional		$43.67	$54.96	$127.15
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.81 / $18.80 / $44.39	Professional	26	$14.81	$18.80	$44.39
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $28.80 / $36.15 / $95.32	Professional	TC	$28.80	$36.15	$95.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.36 / $17.36 / $17.36	Facility	26	$17.36	$17.36	$17.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.07 / $61.82 / $132.74	Professional		$41.07	$61.82	$132.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.40 / $19.42 / $42.52	Professional	26	$13.40	$19.42	$42.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.97 / $41.97 / $94.62	Professional	TC	$27.97	$41.97	$94.62
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $39.42 / $64.48 / $87.05	Professional		$39.42	$64.48	$87.05
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $17.05 / $23.03	Professional	26	$13.80	$17.05	$23.03
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.62 / $47.42 / $64.02	Professional	TC	$25.62	$47.42	$64.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $47.49 / $64.25 / $106.71	Professional		$47.49	$64.25	$106.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.10 / $20.47 / $32.39	Professional	26	$15.10	$20.47	$32.39
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $37.94 / $54.90 / $89.01	Professional	TC	$37.94	$54.90	$89.01
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $46.63 / $100.00 / $100.00	Facility	26	$46.63	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $321.19 / $321.19 / $420.00	Professional		$321.19	$321.19	$420.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $128.79 / $128.79 / $128.79	Professional	26	$128.79	$128.79	$128.79
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $254.00 / $254.00 / $295.35	Professional	TC	$254.00	$254.00	$295.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $38.25	Professional		$32.34	$32.34	$38.25
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.36 / $17.36 / $17.36	Facility	26	$17.36	$17.36	$17.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $42.26 / $66.87 / $133.88	Professional		$42.26	$66.87	$133.88
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.51 / $18.95 / $42.33	Professional	26	$13.51	$18.95	$42.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.00 / $41.15 / $90.83	Professional	TC	$28.00	$41.15	$90.83
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $160.77 / $160.77 / $160.77	Professional		$160.77	$160.77	$160.77
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $51.93 / $51.93 / $51.93	Professional	26	$51.93	$51.93	$51.93
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $108.84 / $108.84 / $108.84	Professional	TC	$108.84	$108.84	$108.84
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $52.14 / $71.69 / $111.78	Professional		$52.14	$71.69	$111.78
United Facility/Professional Professional Modifier Low / Median / High Price $35.53 / $51.53 / $123.02	Professional		$35.53	$51.53	$123.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.45 / $17.45 / $40.84	Professional	26	$12.45	$17.45	$40.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.15 / $34.03 / $84.62	Professional	TC	$24.15	$34.03	$84.62