Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.06 / $14.86 / $86.50	Facility	26	$14.06	$14.86	$86.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.52 / $56.86 / $250.66	Professional		$46.52	$56.86	$250.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $14.60 / $52.85	Professional	26	$12.88	$14.60	$52.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.04 / $40.50 / $112.58	Professional	TC	$33.04	$40.50	$112.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $51.22 / $60.60 / $60.60	Professional		$51.22	$60.60	$60.60
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.62 / $10.62 / $10.62	Professional	26	$10.62	$10.62	$10.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $52.39 / $52.39 / $52.39	Professional	TC	$52.39	$52.39	$52.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.86 / $127.23 / $213.02	Professional		$52.86	$127.23	$213.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.75 / $31.77 / $52.81	Professional	26	$14.75	$31.77	$52.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.46 / $96.26 / $159.65	Professional	TC	$40.46	$96.26	$159.65
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $52.20 / $68.59 / $156.77	Professional		$52.20	$68.59	$156.77
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.26 / $17.09 / $43.97	Professional	26	$13.26	$17.09	$43.97
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $39.79 / $51.54 / $116.38	Professional	TC	$39.79	$51.54	$116.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.20 / $16.20 / $16.20	Facility	26	$16.20	$16.20	$16.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.83 / $71.23 / $153.35	Professional		$47.83	$71.23	$153.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.72 / $18.86 / $40.65	Professional	26	$12.72	$18.86	$40.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.50 / $53.53 / $112.73	Professional	TC	$35.50	$53.53	$112.73
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $47.10 / $70.20 / $94.77	Professional		$47.10	$70.20	$94.77
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.25 / $15.75 / $21.26	Professional	26	$12.25	$15.75	$21.26
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.85 / $54.45 / $73.51	Professional	TC	$34.85	$54.45	$73.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $52.93 / $69.69 / $119.34	Professional		$52.93	$69.69	$119.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.91 / $18.89 / $29.61	Professional	26	$13.91	$18.89	$29.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $43.56 / $63.12 / $102.33	Professional	TC	$43.56	$63.12	$102.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $70.00 / $70.00	Facility	26	$50.00	$70.00	$70.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $325.58 / $325.58 / $454.50	Professional		$325.58	$325.58	$454.50
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.83 / $91.83 / $112.65	Professional	26	$91.83	$91.83	$112.65
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $233.75 / $233.75 / $341.85	Professional	TC	$233.75	$233.75	$341.85
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $35.36	Professional		$32.34	$32.34	$35.36
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.20 / $16.20 / $16.20	Facility	26	$16.20	$16.20	$16.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $49.26 / $79.87 / $146.06	Professional		$49.26	$79.87	$146.06
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.82 / $18.47 / $39.67	Professional	26	$12.82	$18.47	$39.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $35.67 / $52.77 / $112.73	Professional	TC	$35.67	$52.77	$112.73
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $177.70 / $177.70 / $177.70	Professional		$177.70	$177.70	$177.70
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $48.42 / $48.42 / $48.42	Professional	26	$48.42	$48.42	$48.42
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $129.27 / $129.27 / $129.27	Professional	TC	$129.27	$129.27	$129.27
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $56.77 / $65.94 / $80.06	Professional		$56.77	$65.94	$80.06
United Facility/Professional Professional Modifier Low / Median / High Price $39.51 / $58.41 / $160.33	Professional		$39.51	$58.41	$160.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.07 / $15.48 / $40.86	Professional	26	$11.07	$15.48	$40.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.44 / $42.86 / $104.17	Professional	TC	$28.44	$42.86	$104.17