Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $81.28 / $229.09	Facility	26	$41.69	$81.28	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $93.33 / $309.03	Professional		$66.07	$93.33	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $54.95 / $186.21	Professional	26	$39.81	$54.95	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $38.90 / $75.86	Professional	TC	$21.88	$38.90	$75.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $75.86 / $154.88	Professional		$66.07	$75.86	$154.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $39.81 / $53.70	Professional	26	$39.81	$39.81	$53.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $107.15 / $213.80	Professional		$72.44	$107.15	$213.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $69.18 / $128.82	Professional	26	$46.77	$69.18	$128.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $37.15 / $87.10	Professional	TC	$24.55	$37.15	$87.10
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $117.49 / $239.88	Professional		$87.10	$117.49	$239.88
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $75.86 / $158.49	Professional	26	$56.23	$75.86	$158.49
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $39.81 / $93.33	Professional	TC	$29.51	$39.81	$93.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $45.71 / $66.07	Facility	26	$10.00	$45.71	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $97.72 / $234.42	Professional		$72.44	$97.72	$234.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.88 / $128.82	Professional	26	$44.67	$58.88	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $40.74 / $104.71	Professional	TC	$24.55	$40.74	$104.71
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $100.00 / $134.90	Professional		$61.66	$100.00	$134.90
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $48.98 / $63.10	Professional	26	$40.74	$48.98	$63.10
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $53.70 / $72.44	Professional	TC	$21.88	$53.70	$72.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $91.20 / $181.97	Professional		$75.86	$91.20	$181.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $43.65 / $75.86	Professional	26	$38.90	$43.65	$75.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $47.86 / $83.18	Professional	TC	$39.81	$47.86	$83.18
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $263.03 / $263.03 / $263.03	Facility	26	$263.03	$263.03	$263.03
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $645.65 / $645.65	Professional		$616.60	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $323.59 / $323.59	Professional	26	$263.03	$323.59	$323.59
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $323.59 / $323.59	Professional	TC	$263.03	$323.59	$323.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $57.54 / $109.65	Professional		$52.48	$57.54	$109.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $102.33 / $218.78	Professional		$74.13	$102.33	$218.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $58.88 / $114.82	Professional	26	$45.71	$58.88	$114.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $38.02 / $85.11	Professional	TC	$24.55	$38.02	$85.11
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $245.47 / $245.47	Professional		$245.47	$245.47	$245.47
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $141.25 / $141.25	Professional	26	$141.25	$141.25	$141.25
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $102.33 / $102.33	Professional	TC	$102.33	$102.33	$102.33
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $87.10 / $112.20	Professional		$61.66	$87.10	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $77.62 / $173.78	Professional		$54.95	$77.62	$173.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $48.98 / $97.72	Professional	26	$33.88	$48.98	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $30.20 / $72.44	Professional	TC	$19.95	$30.20	$72.44