Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $25.70 / $87.10	Facility	26	$18.20	$25.70	$87.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $70.79 / $223.87	Professional		$28.84	$70.79	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $48.98 / $125.89	Professional	26	$18.20	$48.98	$125.89
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $16.98 / $70.79 / $263.03	Professional	50	$16.98	$70.79	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.12 / $26.30 / $89.13	Professional	TC	$9.12	$26.30	$89.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $66.07 / $141.25	Professional		$43.65	$66.07	$141.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $52.48 / $75.86	Professional	26	$29.51	$52.48	$75.86
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $79.43 / $79.43 / $79.43	Professional	50	$79.43	$79.43	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $51.29 / $66.07	Professional	TC	$21.38	$51.29	$66.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $42.66 / $117.49	Professional		$30.20	$42.66	$117.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $26.30 / $57.54	Professional	26	$19.50	$26.30	$57.54
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $43.65 / $85.11 / $125.89	Professional	50	$43.65	$85.11	$125.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $15.49 / $64.57	Professional	TC	$10.47	$15.49	$64.57
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $48.98 / $107.15	Professional		$33.88	$48.98	$107.15
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $31.62 / $61.66	Professional	26	$21.88	$31.62	$61.66
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $11.75 / $17.78 / $47.86	Professional	TC	$11.75	$17.78	$47.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $53.70	Facility	26	$7.94	$37.15	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $52.48 / $123.03	Professional		$32.36	$52.48	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $29.51 / $64.57	Professional	26	$21.38	$29.51	$64.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $19.05 / $69.18	Professional	TC	$10.72	$19.05	$69.18
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $81.28 / $109.65	Professional		$26.30	$81.28	$109.65
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $37.15 / $50.12	Professional	26	$17.38	$37.15	$50.12
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $8.71 / $44.67 / $60.26	Professional	TC	$8.71	$44.67	$60.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $77.62 / $131.83	Professional		$61.66	$77.62	$131.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $43.65 / $72.44	Professional	26	$32.36	$43.65	$72.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $50.12 / $87.10	Professional	TC	$34.67	$50.12	$87.10
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $162.18 / $162.18	Facility	26	$162.18	$162.18	$162.18
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $537.03 / $537.03	Professional		$363.08	$537.03	$537.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $263.03 / $263.03	Professional	26	$194.98	$263.03	$263.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $269.15 / $269.15	Professional	TC	$213.80	$269.15	$269.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $38.90 / $58.88	Professional		$27.54	$38.90	$58.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $37.15 / $53.70	Facility	26	$7.94	$37.15	$53.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $53.70 / $141.25	Professional		$32.36	$53.70	$141.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $28.18 / $61.66	Professional	26	$21.38	$28.18	$61.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $17.78 / $66.07	Professional	TC	$10.72	$17.78	$66.07
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Professional		$190.55	$190.55	$190.55
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $79.43 / $79.43	Professional	26	$79.43	$79.43	$79.43
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	TC	$109.65	$109.65	$109.65
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $44.67 / $74.13	Professional		$26.30	$44.67	$74.13
United Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $56.23 / $123.03	Professional		$25.12	$56.23	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $25.12 / $53.70	Professional	26	$16.60	$25.12	$53.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $8.51 / $29.51 / $64.57	Professional	TC	$8.51	$29.51	$64.57