Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.88 / $26.04 / $166.83	Facility	26	$24.88	$26.04	$166.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $94.57 / $444.00	Professional		$64.31	$94.57	$444.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.46 / $33.24 / $141.00	Professional	26	$23.46	$33.24	$141.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $26.72 / $49.41 / $412.91	Professional	52	$26.72	$49.41	$412.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.71 / $63.28 / $175.91	Professional	TC	$32.71	$63.28	$175.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.85 / $50.92 / $127.68	Professional		$35.85	$50.92	$127.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.10 / $31.21 / $60.96	Professional	26	$20.10	$31.21	$60.96
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $10.13 / $48.02 / $80.20	Professional	52	$10.13	$48.02	$80.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.65 / $56.65 / $64.51	Professional	TC	$56.65	$56.65	$64.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.75 / $113.35 / $228.07	Professional		$77.75	$113.35	$228.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.15 / $38.01 / $73.52	Professional	26	$26.15	$38.01	$73.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.70 / $74.70 / $147.57	Professional	TC	$47.70	$74.70	$147.57
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $71.94 / $93.85 / $214.06	Professional		$71.94	$93.85	$214.06
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.17 / $31.39 / $87.42	Professional	26	$25.17	$31.39	$87.42
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $46.51 / $61.83 / $140.51	Professional	TC	$46.51	$61.83	$140.51
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.97 / $30.97 / $30.97	Facility	26	$30.97	$30.97	$30.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.29 / $101.73 / $226.27	Professional		$69.29	$101.73	$226.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.63 / $34.36 / $74.37	Professional	26	$23.63	$34.36	$74.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.20 / $68.14 / $149.41	Professional	TC	$42.20	$68.14	$149.41
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $53.17 / $72.29 / $97.59	Professional		$53.17	$72.29	$97.59
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.42 / $29.92 / $40.39	Professional	26	$15.42	$29.92	$40.39
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.75 / $43.41 / $57.20	Professional	TC	$37.75	$43.41	$57.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $56.81 / $74.48 / $142.51	Professional		$56.81	$74.48	$142.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.61 / $37.40 / $62.97	Professional	26	$26.61	$37.40	$62.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.58 / $49.73 / $83.17	Professional	TC	$34.58	$49.73	$83.17
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $73.63 / $122.62 / $132.47	Facility	26	$73.63	$122.62	$132.47
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $447.95 / $456.91 / $482.48	Professional		$447.95	$456.91	$482.48
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $265.83 / $265.83 / $265.83	Professional	26	$265.83	$265.83	$265.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $398.99 / $406.97 / $406.97	Professional	TC	$398.99	$406.97	$406.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $49.48	Professional		$32.34	$32.34	$49.48
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $30.97 / $30.97 / $30.97	Facility	26	$30.97	$30.97	$30.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $69.88 / $107.35 / $204.68	Professional		$69.88	$107.35	$204.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.89 / $33.59 / $72.89	Professional	26	$23.89	$33.59	$72.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.20 / $68.14 / $149.41	Professional	TC	$42.20	$68.14	$149.41
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $262.89 / $262.89 / $262.89	Professional		$262.89	$262.89	$262.89
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $93.94 / $93.94 / $93.94	Professional	26	$93.94	$93.94	$93.94
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $168.94 / $168.94 / $168.94	Professional	TC	$168.94	$168.94	$168.94
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $58.45 / $74.44 / $90.40	Professional		$58.45	$74.44	$90.40
United Facility/Professional Professional Modifier Low / Median / High Price $63.37 / $80.48 / $264.63	Professional		$63.37	$80.48	$264.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.97 / $29.59 / $81.72	Professional	26	$19.97	$29.59	$81.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.59 / $51.26 / $154.47	Professional	TC	$42.59	$51.26	$154.47