Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $17.38 / $25.12	Facility	26	$12.02	$17.38	$25.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $64.57 / $257.04	Professional		$51.29	$64.57	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $20.42 / $57.54	Professional	26	$11.22	$20.42	$57.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $48.98 / $114.82	Professional	TC	$38.90	$48.98	$114.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $56.23 / $89.13	Professional		$47.86	$56.23	$89.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $15.49 / $30.90	Professional	26	$10.72	$15.49	$30.90
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $13.80 / $13.80 / $13.80	Professional	52	$13.80	$13.80	$13.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $117.49 / $117.49	Professional	TC	$117.49	$117.49	$117.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $75.86 / $141.25	Professional		$56.23	$75.86	$141.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $15.49 / $29.51	Professional	26	$11.75	$15.49	$29.51
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $58.88 / $112.20	Professional	TC	$44.67	$58.88	$112.20
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $74.13 / $138.04	Professional		$54.95	$74.13	$138.04
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $15.85 / $29.51	Professional	26	$11.75	$15.85	$29.51
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $57.54 / $109.65	Professional	TC	$43.65	$57.54	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $75.86 / $141.25	Professional		$57.54	$75.86	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $16.22 / $30.20	Professional	26	$12.59	$16.22	$30.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $58.88 / $112.20	Professional	TC	$44.67	$58.88	$112.20
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $87.10 / $112.20	Professional		$47.86	$87.10	$112.20
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.13 / $18.20	Professional	26	$10.00	$14.13	$18.20
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $72.44 / $93.33	Professional	TC	$38.02	$72.44	$93.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $77.62 / $131.83	Professional		$61.66	$77.62	$131.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $14.13 / $22.91	Professional	26	$11.48	$14.13	$22.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $72.44 / $114.82	Professional	TC	$53.70	$72.44	$114.82
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $79.43 / $85.11	Facility	26	$79.43	$79.43	$85.11
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $478.63 / $478.63	Professional		$346.74	$478.63	$478.63
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $93.33 / $93.33	Professional	26	$74.13	$93.33	$93.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $380.19 / $380.19	Professional	TC	$269.15	$380.19	$380.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $60.26 / $75.86	Professional		$16.98	$60.26	$75.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $77.62 / $141.25	Professional		$57.54	$77.62	$141.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $15.85 / $28.84	Professional	26	$12.59	$15.85	$28.84
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $57.54 / $109.65	Professional	TC	$44.67	$57.54	$109.65
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $177.83 / $177.83	Professional		$177.83	$177.83	$177.83
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $39.81 / $39.81	Professional	26	$39.81	$39.81	$39.81
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $138.04 / $138.04	Professional	TC	$138.04	$138.04	$138.04
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $72.44 / $87.10	Professional		$47.86	$72.44	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $58.88 / $117.49	Professional		$42.66	$58.88	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $13.18 / $25.12	Professional	26	$9.77	$13.18	$25.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $45.71 / $91.20	Professional	TC	$33.11	$45.71	$91.20