Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.45 / $3.91 / $18.63	Facility	26	$3.45	$3.91	$18.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.92 / $54.25 / $163.83	Professional		$25.92	$54.25	$163.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.17 / $4.99 / $15.56	Professional	26	$3.17	$4.99	$15.56
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.69 / $16.70 / $67.53	Professional	52	$10.69	$16.70	$67.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.78 / $34.75 / $95.00	Professional	TC	$22.78	$34.75	$95.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.74 / $27.22 / $56.76	Professional		$20.74	$27.22	$56.76
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $2.66 / $4.93 / $14.91	Professional	26	$2.66	$4.93	$14.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.82 / $19.82 / $41.82	Professional	TC	$19.82	$19.82	$41.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.20 / $80.31 / $193.27	Professional		$36.20	$80.31	$193.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $4.05 / $6.61 / $11.11	Professional	26	$4.05	$6.61	$11.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.82 / $72.84 / $186.66	Professional	TC	$31.82	$72.84	$186.66
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $35.86 / $47.58 / $106.29	Professional		$35.86	$47.58	$106.29
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $3.50 / $4.38 / $11.25	Professional	26	$3.50	$4.38	$11.25
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $42.94 / $100.00	Professional	TC	$32.36	$42.94	$100.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.49 / $3.49 / $3.49	Facility	26	$3.49	$3.49	$3.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.03 / $48.01 / $146.34	Professional		$27.03	$48.01	$146.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.53 / $4.67 / $9.67	Professional	26	$3.53	$4.67	$9.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.15 / $43.97 / $141.13	Professional	TC	$25.15	$43.97	$141.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $30.46 / $77.88 / $116.82	Professional		$30.46	$77.88	$116.82
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2.34 / $3.38 / $4.55	Professional	26	$2.34	$3.38	$4.55
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.08 / $75.54 / $113.31	Professional	TC	$27.08	$75.54	$113.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $22.03 / $30.46 / $61.00	Professional		$22.03	$30.46	$61.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $3.00 / $4.21 / $7.11	Professional	26	$3.00	$4.21	$7.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.06 / $32.33 / $59.03	Professional	TC	$22.06	$32.33	$59.03
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $39.94 / $101.15 / $137.01	Facility	26	$39.94	$101.15	$137.01
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $572.89 / $724.06 / $724.06	Professional		$572.89	$724.06	$724.06
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $175.02 / $289.41 / $289.41	Professional	26	$175.02	$289.41	$289.41
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $660.75 / $680.57 / $680.57	Professional	TC	$660.75	$680.57	$680.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.20 / $32.34 / $32.34	Professional		$27.20	$32.34	$32.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.49 / $3.49 / $3.49	Facility	26	$3.49	$3.49	$3.49
Providence Facility/Professional Professional Modifier Low / Median / High Price $27.81 / $48.18 / $130.47	Professional		$27.81	$48.18	$130.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $3.57 / $4.65 / $8.60	Professional	26	$3.57	$4.65	$8.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $25.51 / $46.34 / $141.61	Professional	TC	$25.51	$46.34	$141.61
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $83.79 / $83.79 / $83.79	Professional		$83.79	$83.79	$83.79
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $10.46 / $10.46 / $10.46	Professional	26	$10.46	$10.46	$10.46
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $73.33 / $73.33 / $73.33	Professional	TC	$73.33	$73.33	$73.33
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $24.65 / $77.88 / $212.53	Professional		$24.65	$77.88	$212.53
United Facility/Professional Professional Modifier Low / Median / High Price $19.92 / $35.32 / $104.87	Professional		$19.92	$35.32	$104.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $2.61 / $3.94 / $9.19	Professional	26	$2.61	$3.94	$9.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.61 / $30.13 / $95.04	Professional	TC	$17.61	$30.13	$95.04