Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.21 / $22.40 / $141.63	Facility	26	$18.21	$22.40	$141.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.20 / $65.39 / $206.00	Professional		$28.20	$65.39	$206.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.17 / $36.26 / $129.00	Professional	26	$17.17	$36.26	$129.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $36.26 / $69.09 / $201.46	Professional	50	$36.26	$69.09	$201.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.18 / $14.99 / $83.82	Professional	TC	$9.18	$14.99	$83.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.17 / $65.63 / $130.36	Professional		$42.17	$65.63	$130.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.21 / $32.61 / $70.68	Professional	26	$24.21	$32.61	$70.68
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $29.79 / $57.88 / $65.76	Professional	TC	$29.79	$57.88	$65.76
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.23 / $42.36 / $101.22	Professional		$27.23	$42.36	$101.22
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.39 / $25.82 / $52.65	Professional	26	$17.39	$25.82	$52.65
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $43.59 / $83.44 / $106.55	Professional	50	$43.59	$83.44	$106.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $9.13 / $14.95 / $56.04	Professional	TC	$9.13	$14.95	$56.04
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $30.29 / $39.03 / $100.00	Professional		$30.29	$39.03	$100.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.73 / $24.48 / $66.98	Professional	26	$19.73	$24.48	$66.98
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $10.56 / $14.08 / $41.75	Professional	TC	$10.56	$14.08	$41.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.43 / $37.43 / $37.43	Facility	26	$37.43	$37.43	$37.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.99 / $53.20 / $143.27	Professional		$31.99	$53.20	$143.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.21 / $29.69 / $67.27	Professional	26	$21.21	$29.69	$67.27
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $84.74 / $84.74 / $84.74	Professional	50	$84.74	$84.74	$84.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.66 / $21.51 / $77.93	Professional	TC	$10.66	$21.51	$77.93
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $26.24 / $79.62 / $107.49	Professional		$26.24	$79.62	$107.49
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.57 / $36.33 / $49.05	Professional	26	$17.57	$36.33	$49.05
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $8.66 / $43.29 / $58.44	Professional	TC	$8.66	$43.29	$58.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.63 / $82.01 / $142.50	Professional		$61.63	$82.01	$142.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.19 / $45.37 / $76.36	Professional	26	$32.19	$45.37	$76.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.63 / $50.81 / $84.96	Professional	TC	$34.63	$50.81	$84.96
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $77.38 / $148.36 / $160.55	Facility	26	$77.38	$148.36	$160.55
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $359.16 / $359.16 / $534.98	Professional		$359.16	$359.16	$534.98
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $193.46 / $197.46 / $265.05	Professional	26	$193.46	$197.46	$265.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $214.27 / $214.27 / $269.93	Professional	TC	$214.27	$214.27	$269.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $39.13	Professional		$32.34	$32.34	$39.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $37.43 / $37.43 / $37.43	Facility	26	$37.43	$37.43	$37.43
Providence Facility/Professional Professional Modifier Low / Median / High Price $32.60 / $68.17 / $147.87	Professional		$32.60	$68.17	$147.87
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.28 / $28.18 / $65.73	Professional	26	$21.28	$28.18	$65.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $10.66 / $20.68 / $69.61	Professional	TC	$10.66	$20.68	$69.61
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $189.42 / $189.42 / $189.42	Professional		$189.42	$189.42	$189.42
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $79.37 / $79.37 / $79.37	Professional	26	$79.37	$79.37	$79.37
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $110.04 / $110.04 / $110.04	Professional	TC	$110.04	$110.04	$110.04
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $34.11 / $64.38 / $88.52	Professional		$34.11	$64.38	$88.52
United Facility/Professional Professional Modifier Low / Median / High Price $25.30 / $58.10 / $145.91	Professional		$25.30	$58.10	$145.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.77 / $24.90 / $78.51	Professional	26	$16.77	$24.90	$78.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $8.52 / $33.20 / $85.48	Professional	TC	$8.52	$33.20	$85.48