Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.83 / $37.19 / $224.20	Facility	26	$34.83	$37.19	$224.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.52 / $142.22 / $488.00	Professional		$81.52	$142.22	$488.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.34 / $48.34 / $194.00	Professional	26	$33.34	$48.34	$194.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.02 / $56.15 / $148.77	Professional	TC	$47.02	$56.15	$148.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.20 / $91.29 / $207.66	Professional		$84.20	$91.29	$207.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.65 / $33.84 / $82.14	Professional	26	$21.65	$33.84	$82.14
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.93 / $126.46 / $248.44	Professional		$95.93	$126.46	$248.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.01 / $49.65 / $98.76	Professional	26	$38.01	$49.65	$98.76
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.08 / $76.55 / $146.77	Professional	TC	$55.08	$76.55	$146.77
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $89.42 / $112.22 / $263.58	Professional		$89.42	$112.22	$263.58
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.79 / $44.83 / $100.07	Professional	26	$34.79	$44.83	$100.07
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $54.63 / $72.48 / $163.63	Professional	TC	$54.63	$72.48	$163.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.65 / $41.65 / $41.65	Facility	26	$41.65	$41.65	$41.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.06 / $119.65 / $254.01	Professional		$78.06	$119.65	$254.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.36 / $48.67 / $107.02	Professional	26	$33.36	$48.67	$107.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.09 / $72.78 / $150.80	Professional	TC	$46.09	$72.78	$150.80
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $76.90 / $108.46 / $146.41	Professional		$76.90	$108.46	$146.41
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.29 / $40.70 / $54.95	Professional	26	$32.29	$40.70	$54.95
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.60 / $67.76 / $91.48	Professional	TC	$44.60	$67.76	$91.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $84.74 / $110.51 / $208.60	Professional		$84.74	$110.51	$208.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.86 / $50.63 / $85.17	Professional	26	$35.86	$50.63	$85.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.21 / $79.56 / $133.06	Professional	TC	$54.21	$79.56	$133.06
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $86.18 / $163.47 / $178.60	Facility	26	$86.18	$163.47	$178.60
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $555.44 / $579.47 / $712.88	Professional		$555.44	$579.47	$712.88
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $269.13 / $269.13 / $288.98	Professional	26	$269.13	$269.13	$288.98
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $351.46 / $351.46 / $423.83	Professional	TC	$351.46	$351.46	$423.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $72.98	Professional		$32.34	$32.34	$72.98
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $41.65 / $41.65 / $41.65	Facility	26	$41.65	$41.65	$41.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $80.67 / $132.00 / $250.66	Professional		$80.67	$132.00	$250.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.75 / $47.07 / $105.22	Professional	26	$33.75	$47.07	$105.22
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $46.09 / $71.58 / $150.28	Professional	TC	$46.09	$71.58	$150.28
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $288.44 / $288.44 / $288.44	Professional		$288.44	$288.44	$288.44
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $125.50 / $125.50 / $125.50	Professional	26	$125.50	$125.50	$125.50
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $162.93 / $162.93 / $162.93	Professional	TC	$162.93	$162.93	$162.93
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $87.71 / $107.66 / $130.72	Professional		$87.71	$107.66	$130.72
United Facility/Professional Professional Modifier Low / Median / High Price $68.08 / $88.42 / $237.26	Professional		$68.08	$88.42	$237.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.57 / $39.34 / $102.65	Professional	26	$27.57	$39.34	$102.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.71 / $49.77 / $142.24	Professional	TC	$38.71	$49.77	$142.24