Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.83 / $49.02 / $273.80	Facility	26	$43.83	$49.02	$273.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.00 / $172.62 / $683.05	Professional		$84.00	$172.62	$683.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.00 / $51.90 / $239.72	Professional	26	$43.00	$51.90	$239.72
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $172.62 / $314.29 / $598.30	Professional	50	$172.62	$314.29	$598.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.92 / $48.90 / $92.65	Professional	TC	$39.92	$48.90	$92.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.28 / $98.25 / $204.44	Professional		$79.28	$98.25	$204.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.86 / $54.29 / $102.16	Professional	26	$38.86	$54.29	$102.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.22 / $111.06 / $219.67	Professional		$85.22	$111.06	$219.67
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.44 / $53.46 / $107.72	Professional	26	$42.44	$53.46	$107.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.10 / $55.73 / $109.78	Professional	TC	$40.10	$55.73	$109.78
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $61.73 / $83.19 / $197.04	Professional		$61.73	$83.19	$197.04
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.68 / $33.96 / $95.60	Professional	26	$24.68	$33.96	$95.60
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $37.10 / $48.53 / $115.16	Professional	TC	$37.10	$48.53	$115.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.33 / $124.63 / $287.58	Professional		$92.33	$124.63	$287.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.16 / $62.96 / $134.57	Professional	26	$48.16	$62.96	$134.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.18 / $67.14 / $162.21	Professional	TC	$46.18	$67.14	$162.21
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $76.84 / $97.46 / $159.80	Professional		$76.84	$97.46	$159.80
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.96 / $50.68 / $68.70	Professional	26	$39.96	$50.68	$68.70
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.88 / $46.78 / $91.08	Professional	TC	$36.88	$46.78	$91.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $90.66 / $115.92 / $206.84	Professional		$90.66	$115.92	$206.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.99 / $51.43 / $91.86	Professional	26	$41.99	$51.43	$91.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.97 / $67.47 / $121.78	Professional	TC	$51.97	$67.47	$121.78
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $103.27 / $201.33 / $221.59	Facility	26	$103.27	$201.33	$221.59
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $641.76 / $641.76 / $774.53	Professional		$641.76	$641.76	$774.53
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $283.72 / $283.72 / $358.73	Professional	26	$283.72	$283.72	$358.73
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $358.05 / $358.05 / $415.80	Professional	TC	$358.05	$358.05	$415.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $132.72	Professional		$32.34	$32.34	$132.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $96.56 / $142.57 / $267.75	Professional		$96.56	$142.57	$267.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.63 / $63.05 / $124.40	Professional	26	$48.63	$63.05	$124.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $46.18 / $67.23 / $146.76	Professional	TC	$46.18	$67.23	$146.76
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $324.60 / $324.60 / $324.60	Professional		$324.60	$324.60	$324.60
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $151.50 / $151.50 / $151.50	Professional	26	$151.50	$151.50	$151.50
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $173.10 / $173.10 / $173.10	Professional	TC	$173.10	$173.10	$173.10
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $79.92 / $107.69 / $146.19	Professional		$79.92	$107.69	$146.19
United Facility/Professional Professional Modifier Low / Median / High Price $76.06 / $105.46 / $279.27	Professional		$76.06	$105.46	$279.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.68 / $51.45 / $123.82	Professional	26	$36.68	$51.45	$123.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.44 / $53.00 / $146.44	Professional	TC	$37.44	$53.00	$146.44