Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.23 / $50.17 / $252.19	Facility	26	$45.23	$50.17	$252.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.34 / $84.04 / $229.09	Professional		$69.34	$84.04	$229.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.40 / $50.17 / $195.00	Professional	26	$40.40	$50.17	$195.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.15 / $31.45 / $73.81	Professional	TC	$24.15	$31.45	$73.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.75 / $35.75 / $35.75	Professional	26	$35.75	$35.75	$35.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.69 / $98.25 / $212.10	Professional		$73.69	$98.25	$212.10
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.55 / $63.06 / $126.23	Professional	26	$47.55	$63.06	$126.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.09 / $36.13 / $87.07	Professional	TC	$25.09	$36.13	$87.07
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $78.06 / $109.50 / $235.74	Professional		$78.06	$109.50	$235.74
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.08 / $71.09 / $142.44	Professional	26	$50.08	$71.09	$142.44
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $39.67 / $97.01	Professional	TC	$27.87	$39.67	$97.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.61 / $46.61 / $46.61	Facility	26	$46.61	$46.61	$46.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.81 / $106.14 / $275.02	Professional		$74.81	$106.14	$275.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.34 / $62.53 / $147.75	Professional	26	$46.34	$62.53	$147.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.89 / $44.43 / $126.45	Professional	TC	$26.89	$44.43	$126.45
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $67.69 / $103.01 / $139.06	Professional		$67.69	$103.01	$139.06
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.32 / $50.04 / $61.41	Professional	26	$43.32	$50.04	$61.41
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.37 / $57.52 / $77.65	Professional	TC	$24.37	$57.52	$77.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $76.40 / $95.26 / $224.56	Professional		$76.40	$95.26	$224.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.18 / $45.49 / $99.17	Professional	26	$37.18	$45.49	$99.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.23 / $57.52 / $125.39	Professional	TC	$42.23	$57.52	$125.39
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $95.51 / $95.51 / $204.09	Facility	26	$95.51	$95.51	$204.09
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $676.25 / $676.25 / $682.65	Professional		$676.25	$676.25	$682.65
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $271.97 / $271.97 / $324.98	Professional	26	$271.97	$271.97	$324.98
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $290.20 / $290.20 / $357.60	Professional	TC	$290.20	$290.20	$357.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $57.66 / $115.85	Professional		$32.34	$57.66	$115.85
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $46.61 / $46.61 / $46.61	Facility	26	$46.61	$46.61	$46.61
Providence Facility/Professional Professional Modifier Low / Median / High Price $78.90 / $114.57 / $230.91	Professional		$78.90	$114.57	$230.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.62 / $61.14 / $120.68	Professional	26	$46.62	$61.14	$120.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.93 / $41.98 / $96.08	Professional	TC	$26.93	$41.98	$96.08
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $254.38 / $254.38 / $254.38	Professional		$254.38	$254.38	$254.38
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $140.72 / $140.72 / $140.72	Professional	26	$140.72	$140.72	$140.72
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $113.64 / $113.64 / $113.64	Professional	TC	$113.64	$113.64	$113.64
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $83.30 / $93.72 / $115.07	Professional		$83.30	$93.72	$115.07
United Facility/Professional Professional Modifier Low / Median / High Price $58.20 / $81.31 / $204.00	Professional		$58.20	$81.31	$204.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.15 / $48.65 / $113.46	Professional	26	$34.15	$48.65	$113.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.47 / $32.56 / $100.41	Professional	TC	$22.47	$32.56	$100.41