Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.51 / $101.38 / $637.54	Facility	26	$96.51	$101.38	$637.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.32 / $216.84 / $764.25	Professional		$158.32	$216.84	$764.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.99 / $134.22 / $504.31	Professional	26	$91.99	$134.22	$504.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.43 / $100.62 / $189.78	Professional	TC	$47.43	$100.62	$189.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.66 / $140.02 / $288.51	Professional		$126.66	$140.02	$288.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $107.79 / $223.14 / $454.00	Professional	26	$107.79	$223.14	$454.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.14 / $323.44 / $786.27	Professional		$229.14	$323.44	$786.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.00 / $146.79 / $291.61	Professional	26	$112.00	$146.79	$291.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.13 / $155.80 / $599.59	Professional	TC	$56.13	$155.80	$599.59
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $203.36 / $293.51 / $647.34	Professional		$203.36	$293.51	$647.34
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $132.10 / $322.02	Professional	26	$100.00	$132.10	$322.02
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $158.41 / $343.83	Professional	TC	$100.00	$158.41	$343.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.40 / $246.44 / $650.09	Professional		$129.40	$246.44	$650.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.08 / $132.32 / $302.50	Professional	26	$93.08	$132.32	$302.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.29 / $80.31 / $461.70	Professional	TC	$33.29	$80.31	$461.70
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $116.24 / $177.07 / $239.04	Professional		$116.24	$177.07	$239.04
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.69 / $124.00 / $167.40	Professional	26	$83.69	$124.00	$167.40
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.54 / $53.07 / $71.64	Professional	TC	$32.54	$53.07	$71.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $140.71 / $180.32 / $348.30	Professional		$140.71	$180.32	$348.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $106.45 / $153.25 / $255.81	Professional	26	$106.45	$153.25	$255.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.02 / $62.36 / $99.77	Professional	TC	$41.02	$62.36	$99.77
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $250.54 / $722.52 / $722.52	Facility	26	$250.54	$722.52	$722.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,014.42 / $3,104.86 / $3,104.86	Professional		$3,014.42	$3,104.86	$3,104.86
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $873.45 / $1,056.82 / $1,056.82	Professional	26	$873.45	$1,056.82	$1,056.82
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,488.46 / $2,563.11 / $2,563.11	Professional	TC	$2,488.46	$2,563.11	$2,563.11
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 $130.26 / $258.05 / $640.30	Professional		$130.26	$258.05	$640.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $93.08 / $132.32 / $291.89	Professional	26	$93.08	$132.32	$291.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.24 / $81.53 / $481.78	Professional	TC	$34.24	$81.53	$481.78
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $439.87 / $439.87 / $439.87	Professional		$439.87	$439.87	$439.87
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $353.87 / $353.87 / $353.87	Professional	26	$353.87	$353.87	$353.87
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $85.99 / $85.99 / $85.99	Professional	TC	$85.99	$85.99	$85.99
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $143.16 / $196.86 / $618.52	Professional		$143.16	$196.86	$618.52
United Facility/Professional Professional Modifier Low / Median / High Price $150.46 / $197.38 / $539.13	Professional		$150.46	$197.38	$539.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.58 / $138.50 / $312.39	Professional	26	$81.58	$138.50	$312.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.99 / $56.04 / $283.07	Professional	TC	$30.99	$56.04	$283.07