Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.64 / $29.10 / $165.64	Facility	26	$26.64	$29.10	$165.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.31 / $66.04 / $254.00	Professional		$57.31	$66.04	$254.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $29.83 / $79.61	Professional	26	$26.30	$29.83	$79.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.82 / $34.90 / $68.30	Professional	TC	$30.82	$34.90	$68.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $59.13 / $59.13 / $110.08	Professional		$59.13	$59.13	$110.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.57 / $25.82 / $34.63	Professional	26	$23.57	$25.82	$34.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.99 / $80.28 / $172.35	Professional		$57.99	$80.28	$172.35
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.09 / $38.17 / $70.93	Professional	26	$28.09	$38.17	$70.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.62 / $41.58 / $95.22	Professional	TC	$29.62	$41.58	$95.22
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $49.51 / $70.51 / $141.46	Professional		$49.51	$70.51	$141.46
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.83 / $35.47 / $85.00	Professional	26	$24.83	$35.47	$85.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $24.46 / $34.94 / $82.53	Professional	TC	$24.46	$34.94	$82.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.36 / $31.36 / $31.36	Facility	26	$31.36	$31.36	$31.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.96 / $84.77 / $204.49	Professional		$62.96	$84.77	$204.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.23 / $36.68 / $75.43	Professional	26	$29.23	$36.68	$75.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.32 / $46.21 / $149.09	Professional	TC	$33.32	$46.21	$149.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $79.53 / $87.48 / $107.37	Professional		$79.53	$87.48	$107.37
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.12 / $33.13 / $40.65	Professional	26	$30.12	$33.13	$40.65
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.40 / $54.34 / $66.69	Professional	TC	$49.40	$54.34	$66.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.85 / $74.53 / $150.00	Professional		$58.85	$74.53	$150.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $34.64 / $54.37	Professional	26	$24.78	$34.64	$54.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.33 / $51.56 / $87.84	Professional	TC	$36.33	$51.56	$87.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $64.69 / $122.62 / $133.05	Facility	26	$64.69	$122.62	$133.05
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $717.26 / $717.26 / $717.26	Professional		$717.26	$717.26	$717.26
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $330.63 / $340.55 / $340.55	Professional	26	$330.63	$340.55	$340.55
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $563.89 / $563.89 / $563.89	Professional	TC	$563.89	$563.89	$563.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $87.52	Professional		$32.34	$32.34	$87.52
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $31.36 / $31.36 / $31.36	Facility	26	$31.36	$31.36	$31.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $63.97 / $94.77 / $177.53	Professional		$63.97	$94.77	$177.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.96 / $36.01 / $70.50	Professional	26	$28.96	$36.01	$70.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $33.32 / $45.68 / $128.32	Professional	TC	$33.32	$45.68	$128.32
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $196.08 / $196.08 / $196.08	Professional		$196.08	$196.08	$196.08
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $93.25 / $93.25 / $93.25	Professional	26	$93.25	$93.25	$93.25
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $102.82 / $102.82 / $102.82	Professional	TC	$102.82	$102.82	$102.82
United Facility/Professional Professional Modifier Low / Median / High Price $46.25 / $61.84 / $134.31	Professional		$46.25	$61.84	$134.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.92 / $29.32 / $59.92	Professional	26	$21.92	$29.32	$59.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.08 / $32.51 / $72.04	Professional	TC	$24.08	$32.51	$72.04