Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.85 / $27.09 / $170.81	Facility	26	$25.85	$27.09	$170.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.73 / $115.12 / $290.52	Professional		$90.73	$115.12	$290.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.26 / $28.43 / $112.11	Professional	26	$24.26	$28.43	$112.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.45 / $86.58 / $207.77	Professional	TC	$66.45	$86.58	$207.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.13 / $52.13 / $52.13	Professional	26	$52.13	$52.13	$52.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.14 / $127.66 / $280.27	Professional		$91.14	$127.66	$280.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.69 / $38.82 / $94.53	Professional	26	$26.69	$38.82	$94.53
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.18 / $90.27 / $201.77	Professional	TC	$64.18	$90.27	$201.77
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $82.74 / $106.47 / $262.35	Professional		$82.74	$106.47	$262.35
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.29 / $29.18 / $73.72	Professional	26	$23.29	$29.18	$73.72
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $58.60 / $78.15 / $189.65	Professional	TC	$58.60	$78.15	$189.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $32.15 / $32.15	Facility	26	$32.15	$32.15	$32.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.47 / $142.83 / $324.27	Professional		$95.47	$142.83	$324.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.53 / $34.57 / $76.59	Professional	26	$24.53	$34.57	$76.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.53 / $108.22 / $260.44	Professional	TC	$69.53	$108.22	$260.44
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $75.29 / $164.31 / $221.82	Professional		$75.29	$164.31	$221.82
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.32 / $31.05 / $41.92	Professional	26	$20.32	$31.05	$41.92
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.96 / $133.25 / $179.89	Professional	TC	$54.96	$133.25	$179.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $119.83 / $162.13 / $269.27	Professional		$119.83	$162.13	$269.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.27 / $37.26 / $58.96	Professional	26	$27.27	$37.26	$58.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $106.60 / $154.07 / $249.83	Professional	TC	$106.60	$154.07	$249.83
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $136.56 / $136.56	Facility	26	$100.00	$136.56	$136.56
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $873.78 / $873.78 / $1,050.68	Professional		$873.78	$873.78	$1,050.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $198.13 / $198.13 / $226.28	Professional	26	$198.13	$198.13	$226.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $695.99 / $695.99 / $824.33	Professional	TC	$695.99	$695.99	$824.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $94.85	Professional		$32.34	$32.34	$94.85
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $32.15 / $32.15	Facility	26	$32.15	$32.15	$32.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.62 / $165.76 / $361.32	Professional		$102.62	$165.76	$361.32
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.64 / $33.96 / $76.28	Professional	26	$24.64	$33.96	$76.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $73.77 / $105.95 / $246.50	Professional	TC	$73.77	$105.95	$246.50
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $411.10 / $411.10 / $411.10	Professional		$411.10	$411.10	$411.10
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $95.49 / $95.49 / $95.49	Professional	26	$95.49	$95.49	$95.49
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $315.61 / $315.61 / $315.61	Professional	TC	$315.61	$315.61	$315.61
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $112.94 / $151.19 / $183.60	Professional		$112.94	$151.19	$183.60
United Facility/Professional Professional Modifier Low / Median / High Price $76.45 / $125.23 / $316.43	Professional		$76.45	$125.23	$316.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.57 / $31.35 / $86.05	Professional	26	$21.57	$31.35	$86.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.84 / $94.91 / $238.22	Professional	TC	$56.84	$94.91	$238.22