Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.14 / $28.84 / $79.43	Facility	26	$15.14	$28.84	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $57.54 / $190.55	Professional		$42.66	$57.54	$190.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $15.85 / $51.29	Professional	26	$12.88	$15.85	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $40.74 / $147.91	Professional	TC	$30.20	$40.74	$147.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $87.10 / $165.96	Professional		$57.54	$87.10	$165.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $24.55 / $45.71	Professional	26	$16.60	$24.55	$45.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $61.66 / $123.03	Professional	TC	$39.81	$61.66	$123.03
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $67.61 / $147.91	Professional		$48.98	$67.61	$147.91
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $18.20 / $41.69	Professional	26	$13.49	$18.20	$41.69
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $50.12 / $107.15	Professional	TC	$35.48	$50.12	$107.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.39 / $15.85 / $22.39	Facility	26	$3.39	$15.85	$22.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $74.13 / $151.36	Professional		$54.95	$74.13	$151.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $20.89 / $43.65	Professional	26	$15.85	$20.89	$43.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $52.48 / $107.15	Professional	TC	$38.90	$52.48	$107.15
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $57.54 / $70.79	Professional		$52.48	$57.54	$70.79
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $16.98 / $20.89	Professional	26	$14.13	$16.98	$20.89
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $40.74 / $50.12	Professional	TC	$37.15	$40.74	$50.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $46.77 / $120.23	Professional		$38.02	$46.77	$120.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $14.13 / $24.55	Professional	26	$12.59	$14.13	$24.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $33.11 / $57.54	Professional	TC	$27.54	$33.11	$57.54
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $91.20 / $91.20	Facility	26	$91.20	$91.20	$91.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $537.03 / $537.03	Professional		$537.03	$537.03	$537.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $109.65 / $109.65	Professional	26	$91.20	$109.65	$109.65
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $234.42 / $234.42	Professional	TC	$223.87	$234.42	$234.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $39.81 / $60.26	Professional		$20.42	$39.81	$60.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $77.62 / $141.25	Professional		$57.54	$77.62	$141.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $20.89 / $39.81	Professional	26	$16.22	$20.89	$39.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $52.48 / $104.71	Professional	TC	$39.81	$52.48	$104.71
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $173.78	Professional		$173.78	$173.78	$173.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $50.12 / $50.12	Professional	26	$50.12	$50.12	$50.12
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $123.03 / $123.03	Professional	TC	$123.03	$123.03	$123.03
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $58.88 / $89.13	Professional		$42.66	$58.88	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $58.88 / $123.03	Professional		$40.74	$58.88	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $17.38 / $34.67	Professional	26	$12.02	$17.38	$34.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $41.69 / $87.10	Professional	TC	$28.18	$41.69	$87.10