Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.79 / $266.93 / $266.93	Facility	26	$43.79	$266.93	$266.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $346.50 / $709.48 / $833.42	Professional		$346.50	$709.48	$833.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $113.54 / $257.12 / $266.93	Professional	26	$113.54	$257.12	$266.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $222.51 / $452.37 / $661.97	Professional	TC	$222.51	$452.37	$661.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $105.46 / $139.06 / $271.58	Professional		$105.46	$139.06	$271.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.31 / $93.75 / $191.00	Professional	26	$45.31	$93.75	$191.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $149.47 / $218.77 / $425.19	Professional		$149.47	$218.77	$425.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.79 / $53.76 / $106.64	Professional	26	$34.79	$53.76	$106.64
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $98.15 / $163.38 / $307.69	Professional	TC	$98.15	$163.38	$307.69
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $106.64 / $169.31 / $446.51	Professional		$106.64	$169.31	$446.51
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.99 / $58.47 / $155.44	Professional	26	$36.99	$58.47	$155.44
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $69.65 / $112.01 / $289.32	Professional	TC	$69.65	$112.01	$289.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.65 / $202.65 / $254.82	Professional		$202.65	$202.65	$254.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.22 / $75.22 / $94.59	Professional	26	$75.22	$75.22	$94.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $127.43 / $127.43 / $160.22	Professional	TC	$127.43	$127.43	$160.22
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $105.16 / $153.63 / $207.41	Professional		$105.16	$153.63	$207.41
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.81 / $52.06 / $70.28	Professional	26	$36.81	$52.06	$70.28
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.34 / $101.58 / $137.13	Professional	TC	$68.34	$101.58	$137.13
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $47.69 / $47.69 / $47.69	Professional	26	$47.69	$47.69	$47.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $118.63 / $153.63 / $288.83	Professional		$118.63	$153.63	$288.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.71 / $64.38 / $107.48	Professional	26	$44.71	$64.38	$107.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.31 / $121.40 / $190.97	Professional	TC	$78.31	$121.40	$190.97
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $331.68 / $417.52 / $420.16	Facility	26	$331.68	$417.52	$420.16
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $968.53 / $997.59 / $997.80	Professional		$968.53	$997.59	$997.80
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $279.39 / $279.39 / $368.63	Professional	26	$279.39	$279.39	$368.63
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $774.95 / $798.20 / $798.20	Professional	TC	$774.95	$798.20	$798.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $124.07 / $222.02 / $283.36	Professional		$124.07	$222.02	$283.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $59.34 / $59.34 / $59.34	Professional	26	$59.34	$59.34	$59.34
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.83 / $102.83 / $102.83	Professional	TC	$102.83	$102.83	$102.83
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $408.25 / $408.25 / $408.25	Professional		$408.25	$408.25	$408.25
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $147.94 / $147.94 / $147.94	Professional	26	$147.94	$147.94	$147.94
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $260.31 / $260.31 / $260.31	Professional	TC	$260.31	$260.31	$260.31
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $124.26 / $147.22 / $178.78	Professional		$124.26	$147.22	$178.78
United Facility/Professional Professional Modifier Low / Median / High Price $105.83 / $144.90 / $367.75	Professional		$105.83	$144.90	$367.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.90 / $49.20 / $130.61	Professional	26	$32.90	$49.20	$130.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.56 / $106.19 / $266.87	Professional	TC	$66.56	$106.19	$266.87