Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $109.65 / $309.03	Facility	26	$56.23	$109.65	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $120.23 / $371.54	Professional		$83.18	$120.23	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $75.86 / $245.47	Professional	26	$53.70	$75.86	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $40.74 / $83.18	Professional	TC	$25.12	$40.74	$83.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $93.33 / $165.96	Professional		$83.18	$93.33	$165.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $57.54 / $151.36	Professional	26	$52.48	$57.54	$151.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $131.83 / $263.03	Professional		$93.33	$131.83	$263.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $89.13 / $165.96	Professional	26	$61.66	$89.13	$165.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $42.66 / $95.50	Professional	TC	$28.18	$42.66	$95.50
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $97.72 / $229.09	Professional		$74.13	$97.72	$229.09
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $66.07 / $147.91	Professional	26	$48.98	$66.07	$147.91
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $32.36 / $83.18	Professional	TC	$23.99	$32.36	$83.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $63.10 / $89.13	Facility	26	$13.49	$63.10	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $120.23 / $288.40	Professional		$89.13	$120.23	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $77.62 / $173.78	Professional	26	$60.26	$77.62	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $44.67 / $114.82	Professional	TC	$28.18	$44.67	$114.82
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $123.03 / $165.96	Professional		$75.86	$123.03	$165.96
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $63.10 / $85.11	Professional	26	$51.29	$63.10	$85.11
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $58.88 / $79.43	Professional	TC	$25.12	$58.88	$79.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $109.65 / $213.80	Professional		$91.20	$109.65	$213.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $58.88 / $102.33	Professional	26	$52.48	$58.88	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $53.70 / $91.20	Professional	TC	$43.65	$53.70	$91.20
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $354.81 / $354.81	Facility	26	$354.81	$354.81	$354.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $794.33 / $794.33	Professional		$741.31	$794.33	$794.33
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $354.81 / $436.52 / $436.52	Professional	26	$354.81	$436.52	$436.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $354.81 / $354.81	Professional	TC	$288.40	$354.81	$354.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $77.62 / $134.90	Professional		$57.54	$77.62	$134.90
Providence Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $269.15	Professional		$93.33	$125.89	$269.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $77.62 / $154.88	Professional	26	$60.26	$77.62	$154.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $43.65 / $93.33	Professional	TC	$28.18	$43.65	$93.33
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Professional		$302.00	$302.00	$302.00
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Professional	26	$190.55	$190.55	$190.55
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $112.20 / $112.20	Professional	TC	$112.20	$112.20	$112.20
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $107.15 / $138.04	Professional		$75.86	$107.15	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $95.50 / $208.93	Professional		$69.18	$95.50	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $63.10 / $131.83	Professional	26	$45.71	$63.10	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.11 / $81.28	Professional	TC	$22.91	$33.11	$81.28