Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.17 / $37.93 / $229.58	Facility	26	$36.17	$37.93	$229.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.80 / $96.31 / $420.00	Professional		$79.80	$96.31	$420.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.38 / $47.79 / $208.54	Professional	26	$35.38	$47.79	$208.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.57 / $56.23 / $187.04	Professional	TC	$40.57	$56.23	$187.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.76 / $75.45 / $174.29	Professional		$56.76	$75.45	$174.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.73 / $40.21 / $84.18	Professional	26	$27.73	$40.21	$84.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.84 / $135.60 / $292.74	Professional		$77.84	$135.60	$292.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.43 / $52.55 / $105.75	Professional	26	$37.43	$52.55	$105.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.11 / $77.62 / $203.26	Professional	TC	$39.11	$77.62	$203.26
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $44.37 / $57.15 / $139.32	Professional		$44.37	$57.15	$139.32
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.00 / $21.74 / $62.66	Professional	26	$18.00	$21.74	$62.66
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $26.38 / $35.18 / $91.83	Professional	TC	$26.38	$35.18	$91.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.19 / $43.19 / $43.19	Facility	26	$43.19	$43.19	$43.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.65 / $122.05 / $252.07	Professional		$63.65	$122.05	$252.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.19 / $48.61 / $106.54	Professional	26	$33.19	$48.61	$106.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.54 / $68.02 / $176.42	Professional	TC	$29.54	$68.02	$176.42
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $98.89 / $108.78 / $133.50	Professional		$98.89	$108.78	$133.50
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $45.86 / $56.28	Professional	26	$41.69	$45.86	$56.28
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.20 / $62.92 / $77.22	Professional	TC	$57.20	$62.92	$77.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $76.25 / $98.89 / $169.44	Professional		$76.25	$98.89	$169.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.89 / $50.03 / $78.38	Professional	26	$36.89	$50.03	$78.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $45.76 / $66.30 / $107.48	Professional	TC	$45.76	$66.30	$107.48
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $98.17 / $183.92 / $183.92	Facility	26	$98.17	$183.92	$183.92
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $706.79 / $1,002.61 / $1,002.61	Professional		$706.79	$1,002.61	$1,002.61
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $238.39 / $238.39 / $302.25	Professional	26	$238.39	$238.39	$302.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $548.75 / $780.59 / $780.59	Professional	TC	$548.75	$780.59	$780.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $44.66	Professional		$32.34	$32.34	$44.66
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.19 / $43.19 / $43.19	Facility	26	$43.19	$43.19	$43.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $65.20 / $134.36 / $219.02	Professional		$65.20	$134.36	$219.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.19 / $47.60 / $104.36	Professional	26	$33.19	$47.60	$104.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.43 / $69.55 / $173.74	Professional	TC	$30.43	$69.55	$173.74
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $236.74 / $236.74 / $236.74	Professional		$236.74	$236.74	$236.74
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $129.10 / $129.10 / $129.10	Professional	26	$129.10	$129.10	$129.10
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $107.63 / $107.63 / $107.63	Professional	TC	$107.63	$107.63	$107.63
United Facility/Professional Professional Modifier Low / Median / High Price $62.27 / $92.47 / $220.13	Professional		$62.27	$92.47	$220.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.42 / $42.82 / $96.22	Professional	26	$30.42	$42.82	$96.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.61 / $42.59 / $114.11	Professional	TC	$27.61	$42.59	$114.11