Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.38 / $20.49 / $107.07	Facility	26	$18.38	$20.49	$107.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.74 / $88.69 / $273.22	Professional		$55.74	$88.69	$273.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.18 / $31.14 / $81.79	Professional	26	$18.18	$31.14	$81.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.68 / $47.72 / $136.00	Professional	TC	$37.68	$47.72	$136.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $44.59 / $51.93 / $110.21	Professional		$44.59	$51.93	$110.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.38 / $19.86 / $86.01	Professional	26	$13.38	$19.86	$86.01
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.93 / $131.91 / $236.52	Professional		$67.93	$131.91	$236.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.10 / $39.29 / $70.15	Professional	26	$22.10	$39.29	$70.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.31 / $91.29 / $161.91	Professional	TC	$46.31	$91.29	$161.91
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $62.59 / $82.26 / $191.79	Professional		$62.59	$82.26	$191.79
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.80 / $23.80 / $62.93	Professional	26	$18.80	$23.80	$62.93
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $43.79 / $58.09 / $136.62	Professional	TC	$43.79	$58.09	$136.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.10 / $20.10 / $20.10	Facility	26	$20.10	$20.10	$20.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.40 / $88.12 / $173.97	Professional		$57.40	$88.12	$173.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.23 / $25.53 / $53.69	Professional	26	$19.23	$25.53	$53.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.71 / $65.18 / $129.06	Professional	TC	$39.71	$65.18	$129.06
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $64.15 / $76.56 / $114.86	Professional		$64.15	$76.56	$114.86
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.48 / $30.63 / $45.95	Professional	26	$19.48	$30.63	$45.95
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $49.14 / $68.91	Professional	TC	$44.67	$49.14	$68.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.17 / $66.89 / $117.68	Professional		$50.17	$66.89	$117.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $24.29 / $40.86	Professional	26	$17.23	$24.29	$40.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.45 / $52.43 / $87.65	Professional	TC	$36.45	$52.43	$87.65
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.47 / $100.00 / $128.36	Facility	26	$41.47	$100.00	$128.36
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $437.57 / $604.11 / $624.04	Professional		$437.57	$604.11	$624.04
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $246.01 / $456.30 / $456.30	Professional	26	$246.01	$456.30	$456.30
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $388.70 / $400.36 / $400.36	Professional	TC	$388.70	$400.36	$400.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $44.73	Professional		$32.34	$32.34	$44.73
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.10 / $20.10 / $20.10	Facility	26	$20.10	$20.10	$20.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.20 / $94.99 / $156.36	Professional		$58.20	$94.99	$156.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.26 / $25.04 / $49.57	Professional	26	$19.26	$25.04	$49.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.96 / $67.08 / $115.85	Professional	TC	$39.96	$67.08	$115.85
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $178.50 / $178.50 / $178.50	Professional		$178.50	$178.50	$178.50
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $60.04 / $60.04 / $60.04	Professional	26	$60.04	$60.04	$60.04
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $118.45 / $118.45 / $118.45	Professional	TC	$118.45	$118.45	$118.45
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $51.88 / $76.56 / $208.95	Professional		$51.88	$76.56	$208.95
United Facility/Professional Professional Modifier Low / Median / High Price $43.60 / $74.75 / $171.05	Professional		$43.60	$74.75	$171.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.56 / $21.15 / $49.06	Professional	26	$14.56	$21.15	$49.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.72 / $48.37 / $107.94	Professional	TC	$27.72	$48.37	$107.94