Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $18.20 / $104.71	Facility	26	$15.85	$18.20	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $93.33 / $416.87	Professional		$54.95	$93.33	$416.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $25.12 / $112.20	Professional	26	$16.22	$25.12	$112.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $48.98 / $199.53 / $199.53	Professional	50	$48.98	$199.53	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $46.77 / $107.15	Professional	TC	$38.02	$46.77	$107.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $58.88 / $77.62	Professional		$52.48	$58.88	$77.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $24.55 / $36.31	Professional	26	$20.89	$24.55	$36.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $77.62 / $169.82	Professional		$57.54	$77.62	$169.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $22.91 / $48.98	Professional	26	$16.98	$22.91	$48.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $54.95 / $120.23	Professional	TC	$39.81	$54.95	$120.23
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $74.13 / $144.54	Professional		$53.70	$74.13	$144.54
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $20.42 / $41.69	Professional	26	$15.85	$20.42	$41.69
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $52.48 / $104.71	Professional	TC	$38.02	$52.48	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $81.28 / $177.83	Professional		$61.66	$81.28	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $23.99 / $50.12	Professional	26	$19.05	$23.99	$50.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $57.54 / $125.89	Professional	TC	$41.69	$57.54	$125.89
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $63.10 / $109.65	Professional		$47.86	$63.10	$109.65
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $19.05 / $28.18	Professional	26	$14.45	$19.05	$28.18
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $44.67 / $81.28	Professional	TC	$33.11	$44.67	$81.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $77.62 / $134.90	Professional		$66.07	$77.62	$134.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $19.95 / $33.88	Professional	26	$17.78	$19.95	$33.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $60.26 / $100.00	Professional	TC	$50.12	$60.26	$100.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $501.19 / $501.19	Professional		$416.87	$501.19	$501.19
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $144.54 / $144.54	Professional	26	$114.82	$144.54	$144.54
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $354.81 / $354.81	Professional	TC	$302.00	$354.81	$354.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $58.88 / $85.11	Professional		$25.70	$58.88	$85.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $83.18 / $169.82	Professional		$61.66	$83.18	$169.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $23.99 / $45.71	Professional	26	$19.05	$23.99	$45.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $57.54 / $109.65	Professional	TC	$42.66	$57.54	$109.65
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $208.93 / $208.93	Professional		$208.93	$208.93	$208.93
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $61.66 / $61.66	Professional	26	$61.66	$61.66	$61.66
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $147.91 / $147.91	Professional	TC	$147.91	$147.91	$147.91
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $72.44 / $97.72	Professional		$51.29	$72.44	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $66.07 / $147.91	Professional		$48.98	$66.07	$147.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $20.42 / $44.67	Professional	26	$15.14	$20.42	$44.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $45.71 / $104.71	Professional	TC	$33.88	$45.71	$104.71