Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.50 / $12.85 / $70.77	Facility	26	$11.50	$12.85	$70.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.20 / $118.70 / $430.00	Professional		$83.20	$118.70	$430.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $12.85 / $57.00	Professional	26	$11.22	$12.85	$57.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $38.83 / $60.85 / $347.25	Professional	52	$38.83	$60.85	$347.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.65 / $107.17 / $210.03	Professional	TC	$72.65	$107.17	$210.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.67 / $83.32 / $163.88	Professional		$60.67	$83.32	$163.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.50 / $20.52	Professional	26	$8.51	$9.50	$20.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $65.84 / $65.84 / $65.84	Professional	TC	$65.84	$65.84	$65.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.33 / $133.05 / $264.61	Professional		$87.33	$133.05	$264.61
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.54 / $16.30 / $38.24	Professional	26	$11.54	$16.30	$38.24
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.05 / $117.45 / $237.86	Professional	TC	$67.05	$117.45	$237.86
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $146.41 / $342.34	Professional		$100.00	$146.41	$342.34
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.65 / $16.00 / $42.33	Professional	26	$12.65	$16.00	$42.33
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $131.36 / $307.74	Professional	TC	$100.00	$131.36	$307.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.54 / $13.54 / $13.54	Facility	26	$13.54	$13.54	$13.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.86 / $135.88 / $270.61	Professional		$87.86	$135.88	$270.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.22 / $16.20 / $35.34	Professional	26	$12.22	$16.20	$35.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.52 / $122.54 / $245.63	Professional	TC	$77.52	$122.54	$245.63
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $52.10 / $99.12 / $146.07	Professional		$52.10	$99.12	$146.07
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.44 / $16.67 / $25.01	Professional	26	$12.44	$16.67	$25.01
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.43 / $67.40 / $129.28	Professional	TC	$35.43	$67.40	$129.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $82.46 / $108.64 / $185.16	Professional		$82.46	$108.64	$185.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.20 / $15.55 / $26.50	Professional	26	$11.20	$15.55	$26.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.90 / $112.39 / $187.91	Professional	TC	$73.90	$112.39	$187.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $27.12 / $100.00 / $125.86	Facility	26	$27.12	$100.00	$125.86
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $692.85 / $768.54 / $789.60	Professional		$692.85	$768.54	$789.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $267.48 / $267.48 / $267.48	Professional	26	$267.48	$267.48	$267.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $596.40 / $698.48 / $717.62	Professional	TC	$596.40	$698.48	$717.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $94.81	Professional		$32.34	$32.34	$94.81
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.54 / $13.54 / $13.54	Facility	26	$13.54	$13.54	$13.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $90.21 / $146.85 / $250.66	Professional		$90.21	$146.85	$250.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.22 / $15.79 / $33.03	Professional	26	$12.22	$15.79	$33.03
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $77.28 / $122.54 / $229.00	Professional	TC	$77.28	$122.54	$229.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $285.04 / $285.04 / $285.04	Professional		$285.04	$285.04	$285.04
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $40.35 / $40.35 / $40.35	Professional	26	$40.35	$40.35	$40.35
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $244.68 / $244.68 / $244.68	Professional	TC	$244.68	$244.68	$244.68
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $78.15 / $112.10 / $142.18	Professional		$78.15	$112.10	$142.18
United Facility/Professional Professional Modifier Low / Median / High Price $67.20 / $108.92 / $258.47	Professional		$67.20	$108.92	$258.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.07 / $13.68 / $33.46	Professional	26	$10.07	$13.68	$33.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.12 / $97.09 / $226.91	Professional	TC	$57.12	$97.09	$226.91