Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.14 / $28.84 / $102.33	Facility	26	$15.14	$28.84	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $48.98 / $169.82	Professional		$36.31	$48.98	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $18.20 / $81.28	Professional	26	$12.88	$18.20	$81.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.20 / $81.28	Professional	TC	$22.91	$30.20	$81.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $64.57 / $208.93	Professional		$48.98	$64.57	$208.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $30.90 / $67.61	Professional	26	$20.42	$30.90	$67.61
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $46.77 / $46.77	Professional	TC	$46.77	$46.77	$46.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $70.79 / $128.82	Professional		$44.67	$70.79	$128.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $22.39 / $43.65	Professional	26	$16.98	$22.39	$43.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $46.77 / $83.18	Professional	TC	$26.92	$46.77	$83.18
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $58.88 / $114.82	Professional		$41.69	$58.88	$114.82
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $22.91 / $42.66	Professional	26	$17.38	$22.91	$42.66
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $35.48 / $77.62	Professional	TC	$23.99	$35.48	$77.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.98 / $18.62 / $26.92	Facility	26	$3.98	$18.62	$26.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $57.54 / $104.71	Professional		$36.31	$57.54	$104.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $20.42 / $40.74	Professional	26	$14.13	$20.42	$40.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $38.90 / $74.13	Professional	TC	$22.91	$38.90	$74.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $63.10 / $85.11	Professional		$33.11	$63.10	$85.11
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.05 / $25.70	Professional	26	$13.80	$19.05	$25.70
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $43.65 / $58.88	Professional	TC	$19.05	$43.65	$58.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $58.88 / $109.65	Professional		$45.71	$58.88	$109.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $21.88 / $35.48	Professional	26	$16.60	$21.88	$35.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $46.77 / $81.28	Professional	TC	$36.31	$46.77	$81.28
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $104.71 / $104.71	Facility	26	$104.71	$104.71	$104.71
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $389.05 / $389.05	Professional		$302.00	$389.05	$389.05
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $131.83 / $131.83	Professional	26	$104.71	$131.83	$131.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $257.04 / $257.04	Professional	TC	$194.98	$257.04	$257.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $32.36 / $44.67	Professional		$19.50	$32.36	$44.67
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.98 / $18.62 / $26.92	Facility	26	$3.98	$18.62	$26.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $60.26 / $117.49	Professional		$38.02	$60.26	$117.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.05 / $37.15	Professional	26	$13.80	$19.05	$37.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $38.02 / $69.18	Professional	TC	$23.44	$38.02	$69.18
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Professional		$151.36	$151.36	$151.36
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $56.23 / $56.23	Professional	26	$56.23	$56.23	$56.23
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	TC	$95.50	$95.50	$95.50
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $51.29 / $60.26	Professional		$33.11	$51.29	$60.26
United Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $46.77 / $97.72	Professional		$36.31	$46.77	$97.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.78 / $35.48	Professional	26	$11.75	$17.78	$35.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $28.84 / $63.10	Professional	TC	$21.38	$28.84	$63.10