Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.24 / $61.34 / $372.95	Facility	26	$58.24	$61.34	$372.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $259.58 / $949.36	Professional		$171.00	$259.58	$949.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.16 / $73.51 / $243.18	Professional	26	$55.16	$73.51	$243.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $105.21 / $201.03 / $419.43	Professional	TC	$105.21	$201.03	$419.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $94.71 / $152.16 / $335.28	Professional		$94.71	$152.16	$335.28
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.86 / $87.68 / $137.16	Professional	26	$44.86	$87.68	$137.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $189.98 / $313.45 / $567.76	Professional		$189.98	$313.45	$567.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.63 / $82.68 / $160.87	Professional	26	$57.63	$82.68	$160.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.25 / $231.14 / $387.13	Professional	TC	$121.25	$231.14	$387.13
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $145.47 / $222.32 / $555.40	Professional		$145.47	$222.32	$555.40
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.02 / $77.67 / $187.24	Professional	26	$57.02	$77.67	$187.24
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $145.75 / $368.99	Professional	TC	$100.00	$145.75	$368.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.44 / $69.44 / $69.44	Facility	26	$69.44	$69.44	$69.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.11 / $261.95 / $509.63	Professional		$137.11	$261.95	$509.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.85 / $72.05 / $170.06	Professional	26	$36.85	$72.05	$170.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.98 / $182.66 / $353.45	Professional	TC	$87.98	$182.66	$353.45
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $144.01 / $193.85 / $261.70	Professional		$144.01	$193.85	$261.70
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.08 / $67.48 / $91.10	Professional	26	$46.08	$67.48	$91.10
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.93 / $126.37 / $170.60	Professional	TC	$97.93	$126.37	$170.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $152.16 / $198.13 / $329.55	Professional		$152.16	$198.13	$329.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.69 / $80.98 / $141.38	Professional	26	$59.69	$80.98	$141.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.41 / $146.12 / $236.92	Professional	TC	$97.41	$146.12	$236.92
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $555.91 / $555.91 / $568.24	Facility	26	$555.91	$555.91	$568.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,403.43 / $1,417.13 / $1,417.13	Professional		$1,403.43	$1,417.13	$1,417.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $384.88 / $384.88 / $487.80	Professional	26	$384.88	$384.88	$487.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,332.00 / $1,332.00 / $1,332.00	Professional	TC	$1,332.00	$1,332.00	$1,332.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $104.28	Professional		$32.34	$32.34	$104.28
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.44 / $69.44 / $69.44	Facility	26	$69.44	$69.44	$69.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $140.34 / $288.89 / $472.36	Professional		$140.34	$288.89	$472.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.51 / $70.29 / $164.64	Professional	26	$36.51	$70.29	$164.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $87.81 / $184.55 / $343.33	Professional	TC	$87.81	$184.55	$343.33
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $546.28 / $546.28 / $546.28	Professional		$546.28	$546.28	$546.28
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $209.03 / $209.03 / $209.03	Professional	26	$209.03	$209.03	$209.03
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $337.24 / $337.24 / $337.24	Professional	TC	$337.24	$337.24	$337.24
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $156.77 / $215.56 / $516.98	Professional		$156.77	$215.56	$516.98
United Facility/Professional Professional Modifier Low / Median / High Price $142.03 / $206.33 / $427.39	Professional		$142.03	$206.33	$427.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.78 / $70.31 / $161.79	Professional	26	$49.78	$70.31	$161.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $141.59 / $308.29	Professional	TC	$86.20	$141.59	$308.29