Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.09 / $16.64 / $88.44	Facility	26	$15.09	$16.64	$88.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $57.50 / $100.94	Professional		$43.65	$57.50	$100.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.12 / $16.23 / $36.43	Professional	26	$13.12	$16.23	$36.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.00 / $42.13 / $66.53	Professional	TC	$30.00	$42.13	$66.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.87 / $75.04 / $159.18	Professional		$53.87	$75.04	$159.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.26 / $21.54 / $42.80	Professional	26	$16.26	$21.54	$42.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.22 / $53.07 / $117.41	Professional	TC	$38.22	$53.07	$117.41
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $41.20 / $59.48 / $128.86	Professional		$41.20	$59.48	$128.86
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $10.99 / $15.70 / $39.19	Professional	26	$10.99	$15.70	$39.19
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $30.34 / $43.34 / $100.00	Professional	TC	$30.34	$43.34	$100.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.25 / $16.25 / $16.25	Facility	26	$16.25	$16.25	$16.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.02 / $77.01 / $168.80	Professional		$57.02	$77.01	$168.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.03 / $21.28 / $50.00	Professional	26	$16.03	$21.28	$50.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.22 / $55.95 / $120.85	Professional	TC	$40.22	$55.95	$120.85
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $52.81 / $58.27 / $71.51	Professional		$52.81	$58.27	$71.51
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.26 / $16.70 / $20.49	Professional	26	$14.26	$16.70	$20.49
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.78 / $41.56 / $51.00	Professional	TC	$37.78	$41.56	$51.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.63 / $48.48 / $121.00	Professional		$38.63	$48.48	$121.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.52 / $15.18 / $33.09	Professional	26	$12.52	$15.18	$33.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.76 / $37.78 / $82.36	Professional	TC	$27.76	$37.78	$82.36
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $32.90 / $54.77 / $80.00	Facility	26	$32.90	$54.77	$80.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $541.00 / $541.00 / $541.00	Professional		$541.00	$541.00	$541.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.83 / $91.83 / $109.58	Professional	26	$91.83	$91.83	$109.58
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $217.68 / $223.65 / $235.95	Professional	TC	$217.68	$223.65	$235.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.26 / $32.34 / $60.53	Professional		$20.26	$32.34	$60.53
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.25 / $16.25 / $16.25	Facility	26	$16.25	$16.25	$16.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $55.51 / $78.95 / $141.47	Professional		$55.51	$78.95	$141.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.16 / $20.94 / $42.43	Professional	26	$16.16	$20.94	$42.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $40.60 / $53.88 / $115.23	Professional	TC	$40.60	$53.88	$115.23
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $172.84 / $172.84 / $172.84	Professional		$172.84	$172.84	$172.84
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $49.58 / $49.58 / $49.58	Professional	26	$49.58	$49.58	$49.58
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $123.26 / $123.26 / $123.26	Professional	TC	$123.26	$123.26	$123.26
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $42.83 / $58.89 / $89.77	Professional		$42.83	$58.89	$89.77
United Facility/Professional Professional Modifier Low / Median / High Price $40.50 / $56.79 / $135.78	Professional		$40.50	$56.79	$135.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.04 / $17.20 / $38.38	Professional	26	$12.04	$17.20	$38.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.93 / $40.17 / $94.72	Professional	TC	$27.93	$40.17	$94.72