Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.69 / $24.54 / $132.32	Facility	26	$21.69	$24.54	$132.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.14 / $37.10 / $144.91	Professional		$32.14	$37.10	$144.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.21 / $24.53 / $100.00	Professional	26	$21.21	$24.53	$100.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.19 / $17.42 / $31.32	Professional	52	$15.19	$17.42	$31.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.55 / $12.28 / $23.52	Professional	TC	$10.55	$12.28	$23.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.75 / $34.99 / $64.86	Professional		$30.75	$34.99	$64.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.85 / $27.05 / $49.10	Professional	26	$18.85	$27.05	$49.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.13 / $26.09 / $26.09	Professional	TC	$19.13	$26.09	$26.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.38 / $48.98 / $95.85	Professional		$33.38	$48.98	$95.85
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.78 / $32.08 / $61.77	Professional	26	$22.78	$32.08	$61.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $11.54 / $16.97 / $32.36	Professional	TC	$11.54	$16.97	$32.36
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $27.66 / $39.52 / $93.41	Professional		$27.66	$39.52	$93.41
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.97 / $25.74 / $59.91	Professional	26	$17.97	$25.74	$59.91
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $9.75 / $13.77 / $32.28	Professional	TC	$9.75	$13.77	$32.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.15 / $25.15 / $25.15	Facility	26	$25.15	$25.15	$25.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.36 / $46.22 / $94.53	Professional		$35.36	$46.22	$94.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.26 / $30.05 / $60.96	Professional	26	$23.26	$30.05	$60.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $11.87 / $15.89 / $33.14	Professional	TC	$11.87	$15.89	$33.14
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $30.12 / $41.19 / $55.61	Professional		$30.12	$41.19	$55.61
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.57 / $24.07 / $32.49	Professional	26	$19.57	$24.07	$32.49
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.54 / $17.13 / $23.13	Professional	TC	$10.54	$17.13	$23.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $31.49 / $38.92 / $77.44	Professional		$31.49	$38.92	$77.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.82 / $27.68 / $50.65	Professional	26	$19.82	$27.68	$50.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $12.62 / $17.89 / $32.25	Professional	TC	$12.62	$17.89	$32.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $51.77 / $98.42 / $106.50	Facility	26	$51.77	$98.42	$106.50
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $209.51 / $209.51 / $283.13	Professional		$209.51	$209.51	$283.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $138.46 / $138.46 / $174.45	Professional	26	$138.46	$138.46	$174.45
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $71.05 / $71.05 / $108.68	Professional	TC	$71.05	$71.05	$108.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.42 / $32.34 / $32.34	Professional		$31.42	$32.34	$32.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $25.15 / $25.15 / $25.15	Facility	26	$25.15	$25.15	$25.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $35.65 / $49.81 / $88.05	Professional		$35.65	$49.81	$88.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.26 / $29.52 / $58.04	Professional	26	$23.26	$29.52	$58.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $11.98 / $15.89 / $30.67	Professional	TC	$11.98	$15.89	$30.67
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $110.12 / $110.12 / $110.12	Professional		$110.12	$110.12	$110.12
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $74.62 / $74.62 / $74.62	Professional	26	$74.62	$74.62	$74.62
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $35.50 / $35.50 / $35.50	Professional	TC	$35.50	$35.50	$35.50
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $30.12 / $37.46 / $51.20	Professional		$30.12	$37.46	$51.20
United Facility/Professional Professional Modifier Low / Median / High Price $26.60 / $35.88 / $78.59	Professional		$26.60	$35.88	$78.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.69 / $24.06 / $52.62	Professional	26	$17.69	$24.06	$52.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $8.64 / $11.73 / $24.97	Professional	TC	$8.64	$11.73	$24.97