Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.39 / $15.13 / $92.88	Facility	26	$14.39	$15.13	$92.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.25 / $61.46 / $170.85	Professional		$37.25	$61.46	$170.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.27 / $15.48 / $55.10	Professional	26	$13.27	$15.48	$55.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.76 / $47.07 / $109.81	Professional	TC	$22.76	$47.07	$109.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $2.78 / $12.43 / $12.43	Professional	26	$2.78	$12.43	$12.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.89 / $92.00 / $152.91	Professional		$43.89	$92.00	$152.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.55 / $22.24 / $66.93	Professional	26	$16.55	$22.24	$66.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.33 / $70.38 / $106.22	Professional	TC	$27.33	$70.38	$106.22
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $35.69 / $46.91 / $173.06	Professional		$35.69	$46.91	$173.06
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.81 / $18.80 / $44.33	Professional	26	$14.81	$18.80	$44.33
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $21.67 / $27.91 / $133.63	Professional	TC	$21.67	$27.91	$133.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.36 / $17.36 / $17.36	Facility	26	$17.36	$17.36	$17.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.97 / $65.34 / $118.33	Professional		$33.97	$65.34	$118.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.34 / $19.30 / $42.52	Professional	26	$13.34	$19.30	$42.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.87 / $45.56 / $83.91	Professional	TC	$20.87	$45.56	$83.91
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $33.15 / $52.54 / $70.93	Professional		$33.15	$52.54	$70.93
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.60 / $16.60 / $22.41	Professional	26	$13.60	$16.60	$22.41
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.55 / $35.95 / $48.53	Professional	TC	$19.55	$35.95	$48.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.96 / $52.54 / $96.00	Professional		$38.96	$52.54	$96.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.75 / $19.92 / $31.21	Professional	26	$14.75	$19.92	$31.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.76 / $41.64 / $67.51	Professional	TC	$28.76	$41.64	$67.51
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.08 / $100.00 / $100.00	Facility	26	$49.08	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $346.50 / $390.88 / $390.88	Professional		$346.50	$390.88	$390.88
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.00 / $103.00 / $121.80	Professional	26	$103.00	$103.00	$121.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $258.12 / $301.75 / $301.75	Professional	TC	$258.12	$301.75	$301.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $24.24 / $32.34 / $32.34	Professional		$24.24	$32.34	$32.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.36 / $17.36 / $17.36	Facility	26	$17.36	$17.36	$17.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $35.74 / $73.06 / $113.91	Professional		$35.74	$73.06	$113.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.51 / $18.98 / $42.33	Professional	26	$13.51	$18.98	$42.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $21.10 / $46.45 / $79.87	Professional	TC	$21.10	$46.45	$79.87
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $133.12 / $133.12 / $133.12	Professional		$133.12	$133.12	$133.12
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $51.93 / $51.93 / $51.93	Professional	26	$51.93	$51.93	$51.93
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $81.19 / $81.19 / $81.19	Professional	TC	$81.19	$81.19	$81.19
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $42.48 / $58.41 / $92.87	Professional		$42.48	$58.41	$92.87
United Facility/Professional Professional Modifier Low / Median / High Price $40.78 / $54.57 / $119.70	Professional		$40.78	$54.57	$119.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.44 / $16.59 / $42.47	Professional	26	$12.44	$16.59	$42.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.54 / $36.08 / $83.21	Professional	TC	$24.54	$36.08	$83.21