Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.82 / $5.97 / $6.67	Facility	26	$5.82	$5.97	$6.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.48 / $6.67 / $103.00	Professional	26	$5.48	$6.67	$103.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.84 / $22.57 / $88.12	Professional	TC	$18.84	$22.57	$88.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.71 / $55.43 / $55.68	Professional	26	$49.71	$55.43	$55.68
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.50 / $32.96 / $59.73	Professional	26	$22.50	$32.96	$59.73
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.30 / $116.44 / $197.61	Professional	TC	$74.30	$116.44	$197.61
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.61 / $81.20 / $100.00	Professional	26	$23.61	$81.20	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $66.66 / $100.00 / $145.13	Professional	TC	$66.66	$100.00	$145.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.15 / $28.15 / $28.15	Facility	26	$28.15	$28.15	$28.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.24 / $33.65 / $72.30	Professional	26	$26.24	$33.65	$72.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.23 / $114.84 / $259.75	Professional	TC	$87.23	$114.84	$259.75
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.27 / $27.31 / $36.86	Professional	26	$25.27	$27.31	$36.86
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.27 / $104.48 / $141.05	Professional	TC	$25.27	$104.48	$141.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.37 / $27.31 / $48.28	Professional	26	$22.37	$27.31	$48.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $76.72 / $100.78 / $182.84	Professional	TC	$76.72	$100.78	$182.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.75 / $96.13 / $120.22	Facility	26	$57.75	$96.13	$120.22
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $145.16 / $149.40 / $196.13	Professional	26	$145.16	$149.40	$196.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $393.12 / $393.12 / $650.17	Professional	TC	$393.12	$393.12	$650.17
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $28.15 / $28.15 / $28.15	Facility	26	$28.15	$28.15	$28.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.53 / $33.58 / $68.66	Professional	26	$26.53	$33.58	$68.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $87.80 / $113.39 / $237.81	Professional	TC	$87.80	$113.39	$237.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.59 / $26.31 / $112.30	Professional	26	$19.59	$26.31	$112.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.91 / $101.17 / $462.63	Professional	TC	$65.91	$101.17	$462.63