Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $11.48 / $16.60	Facility	26	$7.94	$11.48	$16.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $66.07 / $257.04	Professional		$52.48	$66.07	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $12.02 / $38.90	Professional	26	$7.59	$12.02	$38.90
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $8.13 / $39.81 / $39.81	Professional	52	$8.13	$39.81	$39.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $54.95 / $131.83	Professional	TC	$43.65	$54.95	$131.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $56.23 / $89.13	Professional		$46.77	$56.23	$89.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $10.96 / $22.91	Professional	26	$7.24	$10.96	$22.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $123.03 / $123.03	Professional	TC	$123.03	$123.03	$123.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $75.86 / $144.54	Professional		$56.23	$75.86	$144.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $10.23 / $21.38	Professional	26	$7.76	$10.23	$21.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $64.57 / $123.03	Professional	TC	$48.98	$64.57	$123.03
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $74.13 / $144.54	Professional		$56.23	$74.13	$144.54
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.47 / $20.42	Professional	26	$7.94	$10.47	$20.42
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $63.10 / $123.03	Professional	TC	$47.86	$63.10	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $77.62 / $151.36	Professional		$57.54	$77.62	$151.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $11.48 / $22.39	Professional	26	$8.91	$11.48	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $66.07 / $125.89	Professional	TC	$48.98	$66.07	$125.89
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $74.13 / $112.20	Professional		$47.86	$74.13	$112.20
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $10.23 / $14.13	Professional	26	$6.76	$10.23	$14.13
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $63.10 / $97.72	Professional	TC	$41.69	$63.10	$97.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $77.62 / $134.90	Professional		$61.66	$77.62	$134.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $10.96 / $17.78	Professional	26	$8.91	$10.96	$17.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $74.13 / $120.23	Professional	TC	$56.23	$74.13	$120.23
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 $371.54 / $467.74 / $467.74	Professional		$371.54	$467.74	$467.74
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $70.79	Professional	26	$54.95	$70.79	$70.79
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $407.38 / $407.38	Professional	TC	$316.23	$407.38	$407.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.59 / $64.57 / $77.62	Professional		$12.59	$64.57	$77.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $77.62 / $151.36	Professional		$58.88	$77.62	$151.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $11.22 / $21.38	Professional	26	$8.91	$11.22	$21.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $64.57 / $123.03	Professional	TC	$48.98	$64.57	$123.03
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Professional		$190.55	$190.55	$190.55
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $29.51 / $29.51	Professional	26	$29.51	$29.51	$29.51
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $158.49 / $158.49	Professional	TC	$158.49	$158.49	$158.49
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $79.43 / $104.71	Professional		$61.66	$79.43	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $60.26 / $123.03	Professional		$43.65	$60.26	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $9.55 / $18.62	Professional	26	$7.08	$9.55	$18.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $51.29 / $104.71	Professional	TC	$37.15	$51.29	$104.71