Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.69 / $46.96 / $279.08	Facility	26	$44.69	$46.96	$279.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.07 / $162.22 / $633.12	Professional		$130.07	$162.22	$633.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.14 / $49.15 / $184.84	Professional	26	$42.14	$49.15	$184.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.10 / $117.54 / $324.17	Professional	TC	$84.10	$117.54	$324.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.27 / $72.27 / $100.85	Professional	26	$72.27	$72.27	$100.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.88 / $219.74 / $426.33	Professional		$141.88	$219.74	$426.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.17 / $64.19 / $130.04	Professional	26	$46.17	$64.19	$130.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.12 / $156.43 / $301.45	Professional	TC	$93.12	$156.43	$301.45
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $137.32 / $342.20	Professional		$100.00	$137.32	$342.20
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.45 / $59.90 / $137.80	Professional	26	$43.45	$59.90	$137.80
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $62.87 / $81.29 / $195.28	Professional	TC	$62.87	$81.29	$195.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.84 / $51.84 / $51.84	Facility	26	$51.84	$51.84	$51.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.45 / $203.68 / $420.07	Professional		$105.45	$203.68	$420.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.95 / $54.72 / $128.55	Professional	26	$27.95	$54.72	$128.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.28 / $147.26 / $296.89	Professional	TC	$76.28	$147.26	$296.89
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $127.28 / $170.30 / $229.91	Professional		$127.28	$170.30	$229.91
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.72 / $49.44 / $66.73	Professional	26	$40.72	$49.44	$66.73
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.55 / $120.86 / $163.16	Professional	TC	$86.55	$120.86	$163.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $133.13 / $173.41 / $289.51	Professional		$133.13	$173.41	$289.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.01 / $59.41 / $100.98	Professional	26	$44.01	$59.41	$100.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $93.16 / $139.74 / $226.60	Professional	TC	$93.16	$139.74	$226.60
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $411.36 / $411.36 / $422.56	Facility	26	$411.36	$411.36	$422.56
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,035.22 / $1,055.73 / $1,108.95	Professional		$1,035.22	$1,055.73	$1,108.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $287.12 / $287.12 / $360.98	Professional	26	$287.12	$287.12	$360.98
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $780.77 / $803.30 / $803.30	Professional	TC	$780.77	$803.30	$803.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $83.53	Professional		$32.34	$32.34	$83.53
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $51.84 / $51.84 / $51.84	Facility	26	$51.84	$51.84	$51.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $113.78 / $238.42 / $399.84	Professional		$113.78	$238.42	$399.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.23 / $52.70 / $127.77	Professional	26	$26.23	$52.70	$127.77
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $74.43 / $148.06 / $290.74	Professional	TC	$74.43	$148.06	$290.74
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $481.02 / $481.02 / $481.02	Professional		$481.02	$481.02	$481.02
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $157.00 / $157.00 / $157.00	Professional	26	$157.00	$157.00	$157.00
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $324.02 / $324.02 / $324.02	Professional	TC	$324.02	$324.02	$324.02
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $137.72 / $189.37 / $390.48	Professional		$137.72	$189.37	$390.48
United Facility/Professional Professional Modifier Low / Median / High Price $124.85 / $166.86 / $375.87	Professional		$124.85	$166.86	$375.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.61 / $49.44 / $121.66	Professional	26	$37.61	$49.44	$121.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.82 / $117.09 / $261.38	Professional	TC	$82.82	$117.09	$261.38