Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.33 / $42.40 / $273.30	Facility	26	$40.33	$42.40	$273.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.57 / $65.89 / $232.20	Professional		$55.57	$65.89	$232.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.99 / $45.63 / $213.00	Professional	26	$37.99	$45.63	$213.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $20.03 / $37.61	Professional	TC	$17.57	$20.03	$37.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.09 / $68.90 / $129.37	Professional		$67.09	$68.90	$129.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.88 / $88.61 / $106.71	Professional	26	$43.88	$88.61	$106.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $66.84 / $84.73 / $168.49	Professional		$66.84	$84.73	$168.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.62 / $59.07 / $117.48	Professional	26	$46.62	$59.07	$117.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.76 / $25.54 / $53.25	Professional	TC	$19.76	$25.54	$53.25
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $62.21 / $77.29 / $183.49	Professional		$62.21	$77.29	$183.49
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.29 / $52.33 / $125.90	Professional	26	$43.29	$52.33	$125.90
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $18.92 / $24.46 / $61.16	Professional	TC	$18.92	$24.46	$61.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.48 / $79.56 / $184.04	Professional		$55.48	$79.56	$184.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.89 / $55.30 / $125.71	Professional	26	$38.89	$55.30	$125.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.53 / $25.46 / $58.91	Professional	TC	$17.53	$25.46	$58.91
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $53.40 / $79.53 / $107.37	Professional		$53.40	$79.53	$107.37
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.85 / $53.23 / $71.86	Professional	26	$36.85	$53.23	$71.86
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.55 / $26.31 / $35.52	Professional	TC	$16.55	$26.31	$35.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.53 / $81.64 / $147.62	Professional		$63.53	$81.64	$147.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $65.81 / $109.87	Professional	26	$45.71	$65.81	$109.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.32 / $30.92 / $49.46	Professional	TC	$20.32	$30.92	$49.46
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $120.26 / $231.56 / $231.56	Facility	26	$120.26	$231.56	$231.56
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $404.61 / $404.61 / $541.88	Professional		$404.61	$404.61	$541.88
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $402.86 / $402.86 / $402.86	Professional	26	$402.86	$402.86	$402.86
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $402.86 / $402.86 / $402.86	Professional	TC	$402.86	$402.86	$402.86
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 $56.25 / $80.75 / $175.06	Professional		$56.25	$80.75	$175.06
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $55.30 / $123.16	Professional	26	$39.81	$55.30	$123.16
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $25.81 / $57.17	Professional	TC	$17.78	$25.81	$57.17
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $214.60 / $214.60 / $214.60	Professional		$214.60	$214.60	$214.60
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $151.44 / $151.44 / $151.44	Professional	26	$151.44	$151.44	$151.44
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $63.15 / $63.15 / $63.15	Professional	TC	$63.15	$63.15	$63.15
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $64.30 / $88.41 / $131.06	Professional		$64.30	$88.41	$131.06
United Facility/Professional Professional Modifier Low / Median / High Price $48.60 / $83.00 / $195.15	Professional		$48.60	$83.00	$195.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.74 / $59.10 / $132.16	Professional	26	$33.74	$59.10	$132.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.07 / $23.90 / $57.80	Professional	TC	$15.07	$23.90	$57.80