Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.35 / $23.71 / $110.06	Facility	26	$21.35	$23.71	$110.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.57 / $44.72 / $123.32	Professional		$36.57	$44.72	$123.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.10 / $23.48 / $59.35	Professional	26	$18.10	$23.48	$59.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.33 / $20.58 / $53.05	Professional	TC	$15.33	$20.58	$53.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $44.86 / $44.86 / $117.10	Professional		$44.86	$44.86	$117.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $54.83 / $121.30	Professional		$40.00	$54.83	$121.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.44 / $29.76 / $61.53	Professional	26	$20.44	$29.76	$61.53
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.20 / $23.91 / $61.07	Professional	TC	$16.20	$23.91	$61.07
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $28.66 / $40.70 / $100.00	Professional		$28.66	$40.70	$100.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.16 / $23.08 / $57.36	Professional	26	$16.16	$23.08	$57.36
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $12.42 / $17.46 / $45.39	Professional	TC	$12.42	$17.46	$45.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.05 / $20.05 / $20.05	Facility	26	$20.05	$20.05	$20.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.95 / $57.95 / $155.47	Professional		$39.95	$57.95	$155.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.02 / $28.90 / $69.19	Professional	26	$21.02	$28.90	$69.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.11 / $30.58 / $92.53	Professional	TC	$17.11	$30.58	$92.53
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $36.33 / $61.50 / $83.03	Professional		$36.33	$61.50	$83.03
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.59 / $21.55 / $26.45	Professional	26	$19.59	$21.55	$26.45
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.26 / $41.91 / $56.58	Professional	TC	$15.26	$41.91	$56.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.86 / $56.31 / $116.00	Professional		$44.86	$56.31	$116.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.01 / $19.59 / $42.71	Professional	26	$16.01	$19.59	$42.71
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.79 / $41.91 / $91.36	Professional	TC	$30.79	$41.91	$91.36
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.24 / $41.24 / $98.31	Facility	26	$41.24	$41.24	$98.31
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $351.65 / $351.65 / $400.65	Professional		$351.65	$351.65	$400.65
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.37 / $131.37 / $139.19	Professional	26	$131.37	$131.37	$139.19
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $214.27 / $214.27 / $261.45	Professional	TC	$214.27	$214.27	$261.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $24.99 / $32.34 / $67.04	Professional		$24.99	$32.34	$67.04
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.05 / $20.05 / $20.05	Facility	26	$20.05	$20.05	$20.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $42.31 / $63.92 / $135.57	Professional		$42.31	$63.92	$135.57
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.02 / $28.40 / $57.04	Professional	26	$21.02	$28.40	$57.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $17.11 / $28.53 / $68.29	Professional	TC	$17.11	$28.53	$68.29
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $143.69 / $143.69 / $143.69	Professional		$143.69	$143.69	$143.69
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $61.30 / $61.30 / $61.30	Professional	26	$61.30	$61.30	$61.30
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $82.39 / $82.39 / $82.39	Professional	TC	$82.39	$82.39	$82.39
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $47.22 / $54.49 / $68.39	Professional		$47.22	$54.49	$68.39
United Facility/Professional Professional Modifier Low / Median / High Price $31.72 / $44.03 / $109.45	Professional		$31.72	$44.03	$109.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.06 / $22.79 / $50.60	Professional	26	$15.06	$22.79	$50.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.42 / $22.91 / $63.32	Professional	TC	$14.42	$22.91	$63.32