Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.72 / $40.67 / $235.06	Facility	26	$38.72	$40.67	$235.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.52 / $60.21 / $237.94	Professional		$52.52	$60.21	$237.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.49 / $39.54 / $111.38	Professional	26	$36.49	$39.54	$111.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.03 / $18.26 / $168.34	Professional	TC	$16.03	$18.26	$168.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $143.08 / $143.08 / $268.77	Professional		$143.08	$143.08	$268.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.74 / $48.74 / $48.74	Professional	26	$48.74	$48.74	$48.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.66 / $103.92 / $291.89	Professional		$68.66	$103.92	$291.89
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.07 / $57.76 / $112.12	Professional	26	$45.07	$57.76	$112.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.69 / $35.85 / $196.92	Professional	TC	$22.69	$35.85	$196.92
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $66.39 / $82.67 / $206.72	Professional		$66.39	$82.67	$206.72
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.45 / $53.77 / $129.32	Professional	26	$44.45	$53.77	$129.32
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $21.94 / $29.30 / $83.31	Professional	TC	$21.94	$29.30	$83.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.86 / $126.82 / $353.91	Professional		$54.86	$126.82	$353.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.96 / $51.36 / $114.47	Professional	26	$35.96	$51.36	$114.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.91 / $82.64 / $242.43	Professional	TC	$13.91	$82.64	$242.43
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $45.73 / $179.36 / $242.14	Professional		$45.73	$179.36	$242.14
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $46.10 / $62.24	Professional	26	$17.38	$46.10	$62.24
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.35 / $133.25 / $179.89	Professional	TC	$28.35	$133.25	$179.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.96 / $181.22 / $315.88	Professional		$138.96	$181.22	$315.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.57 / $56.97 / $95.06	Professional	26	$39.57	$56.97	$95.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.71 / $156.26 / $250.51	Professional	TC	$102.71	$156.26	$250.51
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $115.35 / $200.31 / $200.31	Facility	26	$115.35	$200.31	$200.31
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $886.70 / $886.70 / $1,149.00	Professional		$886.70	$886.70	$1,149.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $414.43 / $414.43 / $414.43	Professional	26	$414.43	$414.43	$414.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $639.54 / $639.54 / $824.33	Professional	TC	$639.54	$639.54	$824.33
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 $57.56 / $130.47 / $317.64	Professional		$57.56	$130.47	$317.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.49 / $51.51 / $111.48	Professional	26	$37.49	$51.51	$111.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $82.34 / $239.69	Professional	TC	$15.14	$82.34	$239.69
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $403.94 / $403.94 / $403.94	Professional		$403.94	$403.94	$403.94
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $130.41 / $130.41 / $130.41	Professional	26	$130.41	$130.41	$130.41
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $273.52 / $273.52 / $273.52	Professional	TC	$273.52	$273.52	$273.52
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $68.59 / $191.17 / $232.13	Professional		$68.59	$191.17	$232.13
United Facility/Professional Professional Modifier Low / Median / High Price $63.37 / $153.84 / $371.78	Professional		$63.37	$153.84	$371.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.63 / $50.98 / $117.46	Professional	26	$32.63	$50.98	$117.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.59 / $102.86 / $254.32	Professional	TC	$16.59	$102.86	$254.32