Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.90 / $55.76 / $290.38	Facility	26	$46.90	$55.76	$290.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $146.81 / $247.94 / $961.35	Professional		$146.81	$247.94	$961.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.18 / $56.90 / $229.01	Professional	26	$44.18	$56.90	$229.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.31 / $201.03 / $373.70	Professional	TC	$98.31	$201.03	$373.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $54.46 / $161.50 / $231.98	Professional		$54.46	$161.50	$231.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.79 / $57.30 / $95.24	Professional	26	$34.79	$57.30	$95.24
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $174.90 / $322.29 / $584.77	Professional		$174.90	$322.29	$584.77
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.31 / $74.27 / $139.71	Professional	26	$51.31	$74.27	$139.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.25 / $247.86 / $449.35	Professional	TC	$121.25	$247.86	$449.35
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $134.09 / $205.52 / $509.89	Professional		$134.09	$205.52	$509.89
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.42 / $61.23 / $144.03	Professional	26	$44.42	$61.23	$144.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $145.75 / $368.85	Professional	TC	$100.00	$145.75	$368.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $122.01 / $266.80 / $520.15	Professional		$122.01	$266.80	$520.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.76 / $61.42 / $135.44	Professional	26	$29.76	$61.42	$135.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.01 / $192.10 / $403.48	Professional	TC	$84.01	$192.10	$403.48
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $124.68 / $169.02 / $228.18	Professional		$124.68	$169.02	$228.18
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.42 / $52.29 / $70.59	Professional	26	$32.42	$52.29	$70.59
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $92.26 / $116.73 / $157.59	Professional	TC	$92.26	$116.73	$157.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $132.13 / $175.00 / $309.95	Professional		$132.13	$175.00	$309.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.25 / $62.75 / $109.55	Professional	26	$46.25	$62.75	$109.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.98 / $134.97 / $218.87	Professional	TC	$89.98	$134.97	$218.87
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $430.56 / $430.56 / $442.24	Facility	26	$430.56	$430.56	$442.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,609.32 / $1,657.60 / $1,657.60	Professional		$1,609.32	$1,657.60	$1,657.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $379.76 / $379.76 / $379.76	Professional	26	$379.76	$379.76	$379.76
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,318.35 / $1,357.90 / $1,357.90	Professional	TC	$1,318.35	$1,357.90	$1,357.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $101.49	Professional		$32.34	$32.34	$101.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $129.90 / $291.45 / $458.30	Professional		$129.90	$291.45	$458.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.36 / $59.18 / $132.94	Professional	26	$29.36	$59.18	$132.94
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $84.01 / $202.74 / $384.71	Professional	TC	$84.01	$202.74	$384.71
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $518.19 / $518.19 / $518.19	Professional		$518.19	$518.19	$518.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $162.91 / $162.91 / $162.91	Professional	26	$162.91	$162.91	$162.91
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $355.28 / $355.28 / $355.28	Professional	TC	$355.28	$355.28	$355.28
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $136.69 / $187.96 / $567.47	Professional		$136.69	$187.96	$567.47
United Facility/Professional Professional Modifier Low / Median / High Price $134.36 / $200.50 / $466.60	Professional		$134.36	$200.50	$466.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.66 / $53.59 / $120.60	Professional	26	$41.66	$53.59	$120.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.80 / $148.22 / $330.29	Professional	TC	$90.80	$148.22	$330.29