Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $47.86 / $251.19	Facility	26	$22.91	$47.86	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $141.25 / $616.60	Professional		$87.10	$141.25	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $34.67 / $213.80	Professional	26	$23.44	$34.67	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $91.20 / $457.09	Professional	TC	$63.10	$91.20	$457.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $229.09 / $229.09	Professional		$229.09	$229.09	$229.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $77.62 / $181.97	Professional	26	$61.66	$77.62	$181.97
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $537.03 / $537.03	Professional	TC	$537.03	$537.03	$537.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $177.83 / $354.81	Professional		$131.83	$177.83	$354.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $45.71 / $91.20	Professional	26	$33.11	$45.71	$91.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $131.83 / $269.15	Professional	TC	$97.72	$131.83	$269.15
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $128.82 / $323.59	Professional		$100.00	$128.82	$323.59
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $11.48 / $93.33	Professional	26	$8.91	$11.48	$93.33
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $109.65 / $181.97	Professional	TC	$85.11	$109.65	$181.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $81.28 / $245.47	Professional		$52.48	$81.28	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.50 / $63.10	Professional	26	$13.80	$19.50	$63.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $61.66 / $186.21	Professional	TC	$38.02	$61.66	$186.21
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $169.82 / $229.09	Professional		$87.10	$169.82	$229.09
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $37.15 / $50.12	Professional	26	$18.20	$37.15	$50.12
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $134.90 / $181.97	Professional	TC	$69.18	$134.90	$181.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $162.18 / $263.03	Professional		$128.82	$162.18	$263.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $42.66 / $77.62	Professional	26	$30.20	$42.66	$77.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $138.04 / $251.19	Professional	TC	$100.00	$138.04	$251.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,071.52 / $1,071.52	Professional		$870.96	$1,071.52	$1,071.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $263.03 / $263.03	Professional	26	$213.80	$263.03	$263.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $812.83 / $812.83	Professional	TC	$660.69	$812.83	$812.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $112.20 / $151.36	Professional		$38.90	$112.20	$151.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $93.33 / $295.12	Professional		$52.48	$93.33	$295.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.95 / $63.10	Professional	26	$13.80	$19.95	$63.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $64.57 / $194.98	Professional	TC	$38.02	$64.57	$194.98
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $524.81 / $524.81	Professional		$524.81	$524.81	$524.81
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $131.83 / $131.83	Professional	26	$131.83	$131.83	$131.83
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $398.11 / $398.11	Professional	TC	$398.11	$398.11	$398.11
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $123.03 / $158.49	Professional		$87.10	$123.03	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $85.11 / $309.03	Professional		$61.66	$85.11	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $21.88 / $79.43	Professional	26	$16.98	$21.88	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $63.10 / $234.42	Professional	TC	$43.65	$63.10	$234.42