Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.43 / $45.64 / $300.24	Facility	26	$43.43	$45.64	$300.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.59 / $112.58 / $421.44	Professional		$95.59	$112.58	$421.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $52.09 / $223.00	Professional	26	$40.96	$52.09	$223.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.72 / $61.87 / $160.16	Professional	TC	$51.72	$61.87	$160.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.98 / $98.36 / $191.67	Professional		$83.98	$98.36	$191.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $68.90 / $83.25 / $114.08	Professional	26	$68.90	$83.25	$114.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $119.58 / $169.50 / $351.62	Professional		$119.58	$169.50	$351.62
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.87 / $66.67 / $128.19	Professional	26	$50.87	$66.67	$128.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.70 / $96.06 / $248.76	Professional	TC	$68.70	$96.06	$248.76
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $103.56 / $150.32 / $343.28	Professional		$103.56	$150.32	$343.28
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.37 / $60.89 / $146.68	Professional	26	$50.37	$60.89	$146.68
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $68.17 / $90.61 / $195.57	Professional	TC	$68.17	$90.61	$195.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.22 / $147.75 / $312.68	Professional		$82.22	$147.75	$312.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.83 / $60.34 / $137.47	Professional	26	$42.83	$60.34	$137.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.01 / $82.35 / $218.07	Professional	TC	$41.01	$82.35	$218.07
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $81.70 / $119.53 / $161.37	Professional		$81.70	$119.53	$161.37
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.67 / $57.88 / $78.14	Professional	26	$41.67	$57.88	$78.14
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.04 / $61.65 / $83.23	Professional	TC	$40.04	$61.65	$83.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $94.41 / $120.82 / $222.90	Professional		$94.41	$120.82	$222.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $49.70 / $71.56 / $119.46	Professional	26	$49.70	$71.56	$119.46
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.56 / $72.33 / $115.90	Professional	TC	$47.56	$72.33	$115.90
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $117.07 / $262.14 / $262.14	Facility	26	$117.07	$262.14	$262.14
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,141.00 / $1,173.03 / $1,173.03	Professional		$1,141.00	$1,173.03	$1,173.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $493.68 / $493.68 / $493.68	Professional	26	$493.68	$493.68	$493.68
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $900.73 / $927.75 / $927.75	Professional	TC	$900.73	$927.75	$927.75
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $82.22 / $156.16 / $275.39	Professional		$82.22	$156.16	$275.39
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.23 / $60.34 / $134.78	Professional	26	$43.23	$60.34	$134.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $41.64 / $87.38 / $204.86	Professional	TC	$41.64	$87.38	$204.86
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $314.07 / $314.07 / $314.07	Professional		$314.07	$314.07	$314.07
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $166.76 / $166.76 / $166.76	Professional	26	$166.76	$166.76	$166.76
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $147.30 / $147.30 / $147.30	Professional	TC	$147.30	$147.30	$147.30
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $96.66 / $132.90 / $436.97	Professional		$96.66	$132.90	$436.97
United Facility/Professional Professional Modifier Low / Median / High Price $94.20 / $122.08 / $314.51	Professional		$94.20	$122.08	$314.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.78 / $65.41 / $150.26	Professional	26	$36.78	$65.41	$150.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.57 / $61.70 / $163.19	Professional	TC	$47.57	$61.70	$163.19