Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.99 / $46.26 / $266.88	Facility	26	$41.99	$46.26	$266.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.05 / $82.57 / $122.79	Professional		$73.05	$82.57	$122.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.40 / $43.71 / $67.93	Professional	26	$39.40	$43.71	$67.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.78 / $40.36 / $70.45	Professional	TC	$33.78	$40.36	$70.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.46 / $94.95 / $102.17	Professional		$85.46	$94.95	$102.17
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.90 / $87.85 / $178.26	Professional		$61.90	$87.85	$178.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.47 / $51.40 / $106.23	Professional	26	$36.47	$51.40	$106.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.00 / $35.65 / $73.56	Professional	TC	$21.00	$35.65	$73.56
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $57.53 / $74.93 / $178.61	Professional		$57.53	$74.93	$178.61
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $29.65 / $40.93 / $100.00	Professional	26	$29.65	$40.93	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $20.92 / $30.18 / $78.95	Professional	TC	$20.92	$30.18	$78.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.48 / $108.12 / $262.64	Professional		$70.48	$108.12	$262.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.31 / $57.59 / $128.35	Professional	26	$45.31	$57.59	$128.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.06 / $52.96 / $130.34	Professional	TC	$24.06	$52.96	$130.34
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $107.98 / $118.78 / $145.77	Professional		$107.98	$118.78	$145.77
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.09 / $54.00 / $66.27	Professional	26	$49.09	$54.00	$66.27
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.90 / $64.79 / $79.52	Professional	TC	$58.90	$64.79	$79.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.27 / $106.30 / $177.56	Professional		$83.27	$106.30	$177.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.67 / $49.11 / $84.12	Professional	26	$40.67	$49.11	$84.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $45.44 / $58.90 / $96.08	Professional	TC	$45.44	$58.90	$96.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $102.35 / $196.79 / $215.13	Facility	26	$102.35	$196.79	$215.13
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $567.30 / $567.30 / $715.35	Professional		$567.30	$567.30	$715.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $318.67 / $318.67 / $349.28	Professional	26	$318.67	$318.67	$349.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $318.67 / $318.67 / $366.08	Professional	TC	$318.67	$318.67	$366.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $121.88	Professional		$32.34	$32.34	$121.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $76.68 / $124.37 / $237.20	Professional		$76.68	$124.37	$237.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.96 / $57.91 / $121.24	Professional	26	$45.96	$57.91	$121.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.40 / $52.83 / $117.90	Professional	TC	$23.40	$52.83	$117.90
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $285.38 / $285.38 / $285.38	Professional		$285.38	$285.38	$285.38
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $148.88 / $148.88 / $148.88	Professional	26	$148.88	$148.88	$148.88
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $136.47 / $136.47 / $136.47	Professional	TC	$136.47	$136.47	$136.47
United Facility/Professional Professional Modifier Low / Median / High Price $64.44 / $88.44 / $244.85	Professional		$64.44	$88.44	$244.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.11 / $49.43 / $129.61	Professional	26	$36.11	$49.43	$129.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.82 / $41.14 / $124.82	Professional	TC	$27.82	$41.14	$124.82