Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.92 / $47.27 / $268.32	Facility	26	$42.92	$47.27	$268.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.87 / $148.08 / $268.81	Professional		$115.87	$148.08	$268.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.21 / $45.43 / $80.95	Professional	26	$40.21	$45.43	$80.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.64 / $105.15 / $159.61	Professional	TC	$72.64	$105.15	$159.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $99.36 / $117.98 / $137.32	Professional		$99.36	$117.98	$137.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.46 / $38.46 / $43.22	Professional	26	$38.46	$38.46	$43.22
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.82 / $144.60 / $284.17	Professional		$96.82	$144.60	$284.17
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.72 / $54.47 / $113.37	Professional	26	$37.72	$54.47	$113.37
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.34 / $89.70 / $181.81	Professional	TC	$47.34	$89.70	$181.81
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $127.60 / $302.72	Professional		$100.00	$127.60	$302.72
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.99 / $42.70 / $101.85	Professional	26	$30.99	$42.70	$101.85
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $59.45 / $81.78 / $193.47	Professional	TC	$59.45	$81.78	$193.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $121.78 / $193.23 / $416.79	Professional		$121.78	$193.23	$416.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.26 / $58.69 / $128.53	Professional	26	$46.26	$58.69	$128.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.87 / $133.19 / $300.26	Professional	TC	$72.87	$133.19	$300.26
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $150.81 / $165.89 / $203.59	Professional		$150.81	$165.89	$203.59
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.23 / $54.15 / $66.45	Professional	26	$49.23	$54.15	$66.45
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $101.58 / $111.74 / $137.13	Professional	TC	$101.58	$111.74	$137.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.73 / $146.27 / $272.20	Professional		$114.73	$146.27	$272.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.83 / $49.26 / $84.49	Professional	26	$40.83	$49.26	$84.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.31 / $101.58 / $165.64	Professional	TC	$78.31	$101.58	$165.64
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $102.69 / $198.29 / $216.22	Facility	26	$102.69	$198.29	$216.22
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $944.58 / $944.58 / $982.43	Professional		$944.58	$944.58	$982.43
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $353.25 / $386.24 / $386.24	Professional	26	$353.25	$386.24	$386.24
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $782.04 / $782.04 / $782.04	Professional	TC	$782.04	$782.04	$782.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $167.94	Professional		$32.34	$32.34	$167.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $130.72 / $208.93 / $373.13	Professional		$130.72	$208.93	$373.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.83 / $59.34 / $122.78	Professional	26	$46.83	$59.34	$122.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $75.95 / $133.88 / $264.43	Professional	TC	$75.95	$133.88	$264.43
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $429.73 / $429.73 / $429.73	Professional		$429.73	$429.73	$429.73
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $150.18 / $150.18 / $150.18	Professional	26	$150.18	$150.18	$150.18
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $279.54 / $279.54 / $279.54	Professional	TC	$279.54	$279.54	$279.54
United Facility/Professional Professional Modifier Low / Median / High Price $101.92 / $141.96 / $386.51	Professional		$101.92	$141.96	$386.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.68 / $49.78 / $141.13	Professional	26	$36.68	$49.78	$141.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.91 / $93.20 / $242.36	Professional	TC	$62.91	$93.20	$242.36