Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.35 / $23.71 / $124.25	Facility	26	$21.35	$23.71	$124.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.25 / $52.35 / $110.08	Professional		$38.25	$52.35	$110.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.45 / $23.48 / $62.74	Professional	26	$19.45	$23.48	$62.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.01 / $21.88 / $61.17	Professional	TC	$17.01	$21.88	$61.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $49.34 / $51.71 / $71.28	Professional		$49.34	$51.71	$71.28
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.09 / $41.09 / $41.09	Professional	26	$41.09	$41.09	$41.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.12 / $59.29 / $128.94	Professional		$41.12	$59.29	$128.94
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.90 / $30.57 / $62.59	Professional	26	$22.90	$30.57	$62.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.55 / $25.65 / $70.36	Professional	TC	$17.55	$25.65	$70.36
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $29.98 / $42.64 / $100.00	Professional		$29.98	$42.64	$100.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.98 / $22.83 / $56.68	Professional	26	$15.98	$22.83	$56.68
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $13.89 / $19.53 / $50.76	Professional	TC	$13.89	$19.53	$50.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.15 / $23.15 / $23.15	Facility	26	$23.15	$23.15	$23.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.98 / $64.37 / $173.52	Professional		$41.98	$64.37	$173.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.29 / $30.21 / $70.69	Professional	26	$22.29	$30.21	$70.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $35.03 / $105.58	Professional	TC	$19.05	$35.03	$105.58
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $70.95 / $95.80	Professional		$38.02	$70.95	$95.80
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.53 / $24.64 / $30.54	Professional	26	$20.53	$24.64	$30.54
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.48 / $48.34 / $65.26	Professional	TC	$17.48	$48.34	$65.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.71 / $64.95 / $118.04	Professional		$51.71	$64.95	$118.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.50 / $22.62 / $49.31	Professional	26	$18.50	$22.62	$49.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.50 / $48.34 / $94.85	Professional	TC	$35.50	$48.34	$94.85
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $47.70 / $80.00 / $99.28	Facility	26	$47.70	$80.00	$99.28
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $378.70 / $378.70 / $461.40	Professional		$378.70	$378.70	$461.40
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $130.11 / $130.11 / $160.35	Professional	26	$130.11	$130.11	$160.35
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $242.47 / $242.47 / $301.05	Professional	TC	$242.47	$242.47	$301.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.83 / $32.34 / $77.13	Professional		$28.83	$32.34	$77.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $23.15 / $23.15 / $23.15	Facility	26	$23.15	$23.15	$23.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.08 / $71.29 / $152.00	Professional		$44.08	$71.29	$152.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.50 / $29.30 / $57.97	Professional	26	$22.50	$29.30	$57.97
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.07 / $32.10 / $77.84	Professional	TC	$19.07	$32.10	$77.84
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $163.83 / $163.83 / $163.83	Professional		$163.83	$163.83	$163.83
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $69.41 / $69.41 / $69.41	Professional	26	$69.41	$69.41	$69.41
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $94.41 / $94.41 / $94.41	Professional	TC	$94.41	$94.41	$94.41
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $49.43 / $57.39 / $78.91	Professional		$49.43	$57.39	$78.91
United Facility/Professional Professional Modifier Low / Median / High Price $34.72 / $49.05 / $129.26	Professional		$34.72	$49.05	$129.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.80 / $23.57 / $55.63	Professional	26	$16.80	$23.57	$55.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.94 / $26.07 / $79.88	Professional	TC	$15.94	$26.07	$79.88