Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.46 / $10.29 / $47.96	Facility	26	$7.46	$10.29	$47.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.68 / $64.87 / $256.77	Professional		$52.68	$64.87	$256.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.53 / $10.26 / $40.00	Professional	26	$7.53	$10.26	$40.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $25.20 / $29.22 / $51.85	Professional	52	$25.20	$29.22	$51.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.02 / $50.39 / $89.08	Professional	TC	$44.02	$50.39	$89.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $47.37 / $55.84 / $85.51	Professional		$47.37	$55.84	$85.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.51 / $9.83 / $19.57	Professional	26	$7.51	$9.83	$19.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $98.46 / $98.46 / $98.46	Professional	TC	$98.46	$98.46	$98.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.99 / $70.20 / $140.77	Professional		$54.99	$70.20	$140.77
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.68 / $9.82 / $19.17	Professional	26	$7.68	$9.82	$19.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.04 / $60.68 / $120.01	Professional	TC	$47.04	$60.68	$120.01
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $45.43 / $64.02 / $130.32	Professional		$45.43	$64.02	$130.32
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $6.19 / $8.84 / $21.49	Professional	26	$6.19	$8.84	$21.49
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $39.08 / $54.98 / $111.89	Professional	TC	$39.08	$54.98	$111.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.06 / $10.06 / $10.06	Facility	26	$10.06	$10.06	$10.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.29 / $77.83 / $168.87	Professional		$58.29	$77.83	$168.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.86 / $11.51 / $24.31	Professional	26	$8.86	$11.51	$24.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.40 / $66.45 / $144.12	Professional	TC	$49.40	$66.45	$144.12
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $48.20 / $74.45 / $96.79	Professional		$48.20	$74.45	$96.79
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.75 / $9.58 / $12.93	Professional	26	$6.75	$9.58	$12.93
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.45 / $64.86 / $84.32	Professional	TC	$41.45	$64.86	$84.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.82 / $67.59 / $129.32	Professional		$53.82	$67.59	$129.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.90 / $11.02 / $20.19	Professional	26	$7.90	$11.02	$20.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.61 / $67.54 / $121.67	Professional	TC	$47.61	$67.54	$121.67
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $20.60 / $70.00 / $85.00	Facility	26	$20.60	$70.00	$85.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $373.69 / $373.69 / $472.95	Professional		$373.69	$373.69	$472.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.28 / $55.28 / $70.05	Professional	26	$55.28	$55.28	$70.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $318.41 / $318.41 / $402.90	Professional	TC	$318.41	$318.41	$402.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.58 / $32.34 / $76.93	Professional		$12.58	$32.34	$76.93
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.06 / $10.06 / $10.06	Facility	26	$10.06	$10.06	$10.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $59.23 / $86.41 / $155.44	Professional		$59.23	$86.41	$155.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.83 / $11.17 / $22.67	Professional	26	$8.83	$11.17	$22.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $49.41 / $66.25 / $130.52	Professional	TC	$49.41	$66.25	$130.52
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $189.07 / $189.07 / $189.07	Professional		$189.07	$189.07	$189.07
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $29.74 / $29.74 / $29.74	Professional	26	$29.74	$29.74	$29.74
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $159.33 / $159.33 / $159.33	Professional	TC	$159.33	$159.33	$159.33
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $60.22 / $67.73 / $91.70	Professional		$60.22	$67.73	$91.70
United Facility/Professional Professional Modifier Low / Median / High Price $43.12 / $59.05 / $131.66	Professional		$43.12	$59.05	$131.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.02 / $9.36 / $18.78	Professional	26	$7.02	$9.36	$18.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.54 / $50.02 / $109.86	Professional	TC	$36.54	$50.02	$109.86