Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.79 / $26.85 / $159.01	Facility	26	$25.79	$26.85	$159.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.06 / $110.32 / $530.00	Professional		$86.06	$110.32	$530.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.64 / $28.09 / $116.30	Professional	26	$24.64	$28.09	$116.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.40 / $73.22 / $289.92	Professional	TC	$61.40	$73.22	$289.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.88 / $94.75 / $140.44	Professional		$66.88	$94.75	$140.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $23.77 / $115.00	Professional	26	$19.05	$23.77	$115.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $59.25 / $59.25 / $59.25	Professional	TC	$59.25	$59.25	$59.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $119.34 / $179.83 / $356.73	Professional		$119.34	$179.83	$356.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.21 / $50.28 / $95.22	Professional	26	$29.21	$50.28	$95.22
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.27 / $132.26 / $262.57	Professional	TC	$95.27	$132.26	$262.57
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $95.68 / $121.77 / $290.43	Professional		$95.68	$121.77	$290.43
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.41 / $33.65 / $95.40	Professional	26	$27.41	$33.65	$95.40
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $68.27 / $90.79 / $210.54	Professional	TC	$68.27	$90.79	$210.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.72 / $29.72 / $29.72	Facility	26	$29.72	$29.72	$29.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $88.83 / $133.63 / $308.76	Professional		$88.83	$133.63	$308.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.91 / $35.38 / $75.75	Professional	26	$23.91	$35.38	$75.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.12 / $100.91 / $247.37	Professional	TC	$65.12	$100.91	$247.37
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $85.45 / $139.72 / $188.64	Professional		$85.45	$139.72	$188.64
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.93 / $28.51 / $38.49	Professional	26	$23.93	$28.51	$38.49
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.52 / $111.22 / $150.15	Professional	TC	$61.52	$111.22	$150.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.62 / $140.05 / $252.61	Professional		$107.62	$140.05	$252.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.30 / $35.63 / $59.96	Professional	26	$25.30	$35.63	$59.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $88.98 / $130.44 / $218.09	Professional	TC	$88.98	$130.44	$218.09
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $61.02 / $116.58 / $126.11	Facility	26	$61.02	$116.58	$126.11
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $692.04 / $692.04 / $896.48	Professional		$692.04	$692.04	$896.48
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $165.29 / $165.29 / $207.90	Professional	26	$165.29	$165.29	$207.90
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $526.74 / $526.74 / $688.58	Professional	TC	$526.74	$526.74	$688.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $89.24	Professional		$32.34	$32.34	$89.24
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $29.72 / $29.72 / $29.72	Facility	26	$29.72	$29.72	$29.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $96.18 / $147.41 / $293.86	Professional		$96.18	$147.41	$293.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.04 / $34.97 / $74.56	Professional	26	$24.04	$34.97	$74.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $67.34 / $98.96 / $229.84	Professional	TC	$67.34	$98.96	$229.84
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $380.90 / $380.90 / $380.90	Professional		$380.90	$380.90	$380.90
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $89.34 / $89.34 / $89.34	Professional	26	$89.34	$89.34	$89.34
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $291.56 / $291.56 / $291.56	Professional	TC	$291.56	$291.56	$291.56
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $111.09 / $127.13 / $155.38	Professional		$111.09	$127.13	$155.38
United Facility/Professional Professional Modifier Low / Median / High Price $81.59 / $115.85 / $305.70	Professional		$81.59	$115.85	$305.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.03 / $28.25 / $77.81	Professional	26	$21.03	$28.25	$77.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.91 / $87.70 / $241.63	Professional	TC	$58.91	$87.70	$241.63