Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.52 / $14.01 / $79.38	Facility	26	$13.52	$14.01	$79.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.85 / $54.56 / $186.00	Professional		$34.85	$54.56	$186.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $17.64 / $58.49	Professional	26	$12.59	$17.64	$58.49
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $16.61 / $21.07 / $82.35	Professional	52	$16.61	$21.07	$82.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.26 / $29.46 / $70.11	Professional	TC	$22.26	$29.46	$70.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.98 / $80.17 / $80.17	Professional		$42.98	$80.17	$80.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.79 / $24.51 / $64.14	Professional	26	$7.79	$24.51	$64.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.79 / $51.02 / $102.26	Professional		$38.79	$51.02	$102.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.42 / $18.09 / $34.92	Professional	26	$14.42	$18.09	$34.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.65 / $33.93 / $67.45	Professional	TC	$24.65	$33.93	$67.45
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $35.19 / $44.29 / $103.12	Professional		$35.19	$44.29	$103.12
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.68 / $16.80 / $38.69	Professional	26	$12.68	$16.80	$38.69
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $21.84 / $27.31 / $70.97	Professional	TC	$21.84	$27.31	$70.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.96 / $14.96 / $14.96	Facility	26	$14.96	$14.96	$14.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.86 / $52.47 / $115.46	Professional		$34.86	$52.47	$115.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.72 / $16.77 / $36.64	Professional	26	$11.72	$16.77	$36.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.57 / $36.15 / $87.04	Professional	TC	$23.57	$36.15	$87.04
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $32.04 / $58.69 / $79.23	Professional		$32.04	$58.69	$79.23
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.50 / $14.49 / $19.55	Professional	26	$12.50	$14.49	$19.55
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.55 / $44.21 / $59.68	Professional	TC	$19.55	$44.21	$59.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.33 / $58.37 / $98.50	Professional		$44.33	$58.37	$98.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.78 / $17.39 / $27.24	Professional	26	$12.78	$17.39	$27.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.36 / $51.18 / $82.98	Professional	TC	$35.36	$51.18	$82.98
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $36.81 / $70.00 / $80.00	Facility	26	$36.81	$70.00	$80.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $290.45 / $290.45 / $381.90	Professional		$290.45	$290.45	$381.90
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.68 / $82.68 / $106.35	Professional	26	$82.68	$82.68	$106.35
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $207.72 / $207.72 / $275.55	Professional	TC	$207.72	$207.72	$275.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $35.32	Professional		$32.34	$32.34	$35.32
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.96 / $14.96 / $14.96	Facility	26	$14.96	$14.96	$14.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $37.54 / $58.55 / $121.30	Professional		$37.54	$58.55	$121.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $16.51 / $36.35	Professional	26	$12.01	$16.51	$36.35
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $49.70 / $49.70 / $52.27	Professional	52	$49.70	$49.70	$52.27
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.27 / $35.11 / $77.69	Professional	TC	$24.27	$35.11	$77.69
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $146.09 / $146.09 / $146.09	Professional		$146.09	$146.09	$146.09
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $44.46 / $44.46 / $44.46	Professional	26	$44.46	$44.46	$44.46
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $101.62 / $101.62 / $101.62	Professional	TC	$101.62	$101.62	$101.62
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $41.66 / $53.40 / $65.26	Professional		$41.66	$53.40	$65.26
United Facility/Professional Professional Modifier Low / Median / High Price $30.69 / $44.75 / $128.38	Professional		$30.69	$44.75	$128.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.55 / $15.40 / $40.04	Professional	26	$10.55	$15.40	$40.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.74 / $31.84 / $95.00	Professional	TC	$20.74	$31.84	$95.00