Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.89 / $60.63 / $366.08	Facility	26	$57.89	$60.63	$366.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $198.25 / $335.70 / $806.60	Professional		$198.25	$335.70	$806.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.83 / $61.28 / $222.77	Professional	26	$53.83	$61.28	$222.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $140.27 / $274.27 / $569.51	Professional	TC	$140.27	$274.27	$569.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.58 / $47.70 / $71.68	Professional	26	$35.58	$47.70	$71.68
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $255.55 / $466.08 / $864.48	Professional		$255.55	$466.08	$864.48
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.96 / $81.72 / $160.88	Professional	26	$56.96	$81.72	$160.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $193.32 / $384.39 / $715.68	Professional	TC	$193.32	$384.39	$715.68
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $224.20 / $341.37 / $813.05	Professional		$224.20	$341.37	$813.05
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.10 / $76.66 / $185.41	Professional	26	$56.10	$76.66	$185.41
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $173.06 / $265.11 / $628.47	Professional	TC	$173.06	$265.11	$628.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.82 / $385.94 / $749.08	Professional		$189.82	$385.94	$749.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $73.83 / $167.60	Professional	26	$36.54	$73.83	$167.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.07 / $299.29 / $607.63	Professional	TC	$141.07	$299.29	$607.63
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $192.07 / $258.82 / $349.41	Professional		$192.07	$258.82	$349.41
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.26 / $66.20 / $89.38	Professional	26	$42.26	$66.20	$89.38
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $149.81 / $192.61 / $260.02	Professional	TC	$149.81	$192.61	$260.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $200.00 / $260.01 / $457.10	Professional		$200.00	$260.01	$457.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.65 / $79.45 / $129.11	Professional	26	$58.65	$79.45	$129.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $148.50 / $222.75 / $361.19	Professional	TC	$148.50	$222.75	$361.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $546.72 / $546.72 / $561.91	Facility	26	$546.72	$546.72	$561.91
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,293.84 / $2,362.66 / $2,362.66	Professional		$2,293.84	$2,362.66	$2,362.66
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $523.40 / $523.40 / $523.40	Professional	26	$523.40	$523.40	$523.40
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,412.00 / $2,412.00 / $2,412.00	Professional	TC	$2,412.00	$2,412.00	$2,412.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $187.36	Professional		$32.34	$32.34	$187.36
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $196.70 / $423.50 / $668.11	Professional		$196.70	$423.50	$668.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.09 / $72.79 / $161.00	Professional	26	$36.09	$72.79	$161.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $141.07 / $307.12 / $572.77	Professional	TC	$141.07	$307.12	$572.77
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $765.12 / $765.12 / $765.12	Professional		$765.12	$765.12	$765.12
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $205.47 / $205.47 / $205.47	Professional	26	$205.47	$205.47	$205.47
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $559.64 / $559.64 / $559.64	Professional	TC	$559.64	$559.64	$559.64
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $209.32 / $287.82 / $618.24	Professional		$209.32	$287.82	$618.24
United Facility/Professional Professional Modifier Low / Median / High Price $197.86 / $300.60 / $663.17	Professional		$197.86	$300.60	$663.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.23 / $65.64 / $159.11	Professional	26	$49.23	$65.64	$159.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $142.94 / $240.53 / $573.66	Professional	TC	$142.94	$240.53	$573.66