Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.24 / $39.50 / $221.26	Facility	26	$31.24	$39.50	$221.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.73 / $180.85 / $650.27	Professional		$124.73	$180.85	$650.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.71 / $40.20 / $150.00	Professional	26	$32.71	$40.20	$150.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $40.43 / $420.00 / $762.00	Professional	52	$40.43	$420.00	$762.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.55 / $104.44 / $409.68	Professional	TC	$87.55	$104.44	$409.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.22 / $133.85 / $301.16	Professional		$95.22	$133.85	$301.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.34 / $40.47 / $81.73	Professional	26	$27.34	$40.47	$81.73
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $57.66 / $70.20 / $106.00	Professional	52	$57.66	$70.20	$106.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.02 / $143.13 / $192.41	Professional	TC	$81.02	$143.13	$192.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $127.71 / $186.16 / $375.65	Professional		$127.71	$186.16	$375.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.64 / $47.99 / $95.92	Professional	26	$32.64	$47.99	$95.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $92.28 / $137.49 / $279.72	Professional	TC	$92.28	$137.49	$279.72
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $156.10 / $364.00	Professional		$100.00	$156.10	$364.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.44 / $38.20 / $100.00	Professional	26	$31.44	$38.20	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $89.51 / $115.30 / $274.60	Professional	TC	$89.51	$115.30	$274.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.44 / $175.75 / $385.59	Professional		$117.44	$175.75	$385.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.67 / $46.30 / $99.92	Professional	26	$31.67	$46.30	$99.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.94 / $130.10 / $284.57	Professional	TC	$87.94	$130.10	$284.57
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $119.45 / $167.00 / $225.45	Professional		$119.45	$167.00	$225.45
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.06 / $40.17 / $54.23	Professional	26	$31.06	$40.17	$54.23
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $88.39 / $126.83 / $171.22	Professional	TC	$88.39	$126.83	$171.22
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $195.75 / $236.41 / $452.20	Professional		$195.75	$236.41	$452.20
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $66.70 / $114.60 / $164.44	Professional	26	$66.70	$114.60	$164.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $126.00 / $165.76 / $269.54	Professional		$126.00	$165.76	$269.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.54 / $48.20 / $75.52	Professional	26	$35.54	$48.20	$75.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $101.46 / $146.63 / $237.77	Professional	TC	$101.46	$146.63	$237.77
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.37 / $177.27 / $177.27	Facility	26	$85.37	$177.27	$177.27
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $825.92 / $825.92 / $1,076.40	Professional		$825.92	$825.92	$1,076.40
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $227.63 / $227.63 / $291.60	Professional	26	$227.63	$227.63	$291.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $598.35 / $598.35 / $784.73	Professional	TC	$598.35	$598.35	$784.73
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $101.71	Professional		$32.34	$32.34	$101.71
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $121.34 / $194.17 / $363.85	Professional		$121.34	$194.17	$363.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.96 / $45.70 / $97.36	Professional	26	$31.96	$45.70	$97.36
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $178.00 / $178.00 / $178.00	Professional	52	$178.00	$178.00	$178.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $87.94 / $129.91 / $284.57	Professional	TC	$87.94	$129.91	$284.57
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $456.88 / $456.88 / $456.88	Professional		$456.88	$456.88	$456.88
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $124.44 / $124.44 / $124.44	Professional	26	$124.44	$124.44	$124.44
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $332.44 / $332.44 / $332.44	Professional	TC	$332.44	$332.44	$332.44
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $135.06 / $167.23 / $203.07	Professional		$135.06	$167.23	$203.07
United Facility/Professional Professional Modifier Low / Median / High Price $109.41 / $153.24 / $412.37	Professional		$109.41	$153.24	$412.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.84 / $43.27 / $92.24	Professional	26	$29.84	$43.27	$92.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.56 / $110.34 / $281.26	Professional	TC	$79.56	$110.34	$281.26