Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.92 / $65.04 / $361.55	Facility	26	$56.92	$65.04	$361.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $137.58 / $275.16 / $1,163.63	Professional		$137.58	$275.16	$1,163.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.92 / $165.38 / $951.00	Professional	26	$56.92	$165.38	$951.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.95 / $102.94 / $406.00	Professional	TC	$79.95	$102.94	$406.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $111.42 / $132.63 / $243.83	Professional		$111.42	$132.63	$243.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.98 / $116.79 / $266.00	Professional	26	$58.98	$116.79	$266.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $159.33 / $218.78 / $413.56	Professional		$159.33	$218.78	$413.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.15 / $83.48 / $168.20	Professional	26	$66.15	$83.48	$168.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.11 / $133.15 / $247.22	Professional	TC	$95.11	$133.15	$247.22
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $142.09 / $206.52 / $471.51	Professional		$142.09	$206.52	$471.51
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.44 / $79.09 / $190.41	Professional	26	$65.44	$79.09	$190.41
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $97.01 / $124.96 / $278.26	Professional	TC	$97.01	$124.96	$278.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.24 / $196.68 / $426.39	Professional		$123.24	$196.68	$426.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.85 / $77.18 / $171.51	Professional	26	$53.85	$77.18	$171.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.38 / $123.30 / $255.08	Professional	TC	$74.38	$123.30	$255.08
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $112.19 / $160.53 / $216.72	Professional		$112.19	$160.53	$216.72
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.36 / $69.95 / $94.45	Professional	26	$49.36	$69.95	$94.45
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.83 / $90.57 / $122.27	Professional	TC	$62.83	$90.57	$122.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $126.26 / $162.28 / $308.64	Professional		$126.26	$162.28	$308.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.06 / $86.44 / $144.33	Professional	26	$60.06	$86.44	$144.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $69.83 / $106.23 / $170.27	Professional	TC	$69.83	$106.23	$170.27
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $141.46 / $347.58 / $347.58	Facility	26	$141.46	$347.58	$347.58
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,049.00 / $1,067.26 / $1,067.26	Professional		$1,049.00	$1,067.26	$1,067.26
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $716.57 / $855.01 / $855.01	Professional	26	$716.57	$855.01	$855.01
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $724.87 / $746.61 / $746.61	Professional	TC	$724.87	$746.61	$746.61
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 $123.85 / $202.90 / $375.38	Professional		$123.85	$202.90	$375.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.04 / $77.18 / $168.43	Professional	26	$55.04	$77.18	$168.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $76.39 / $125.28 / $238.91	Professional	TC	$76.39	$125.28	$238.91
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $424.87 / $424.87 / $424.87	Professional		$424.87	$424.87	$424.87
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $200.62 / $200.62 / $200.62	Professional	26	$200.62	$200.62	$200.62
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $224.24 / $224.24 / $224.24	Professional	TC	$224.24	$224.24	$224.24
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $129.82 / $178.51 / $316.52	Professional		$129.82	$178.51	$316.52
United Facility/Professional Professional Modifier Low / Median / High Price $126.35 / $163.78 / $365.42	Professional		$126.35	$163.78	$365.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.84 / $78.50 / $191.56	Professional	26	$47.84	$78.50	$191.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.76 / $92.85 / $221.37	Professional	TC	$67.76	$92.85	$221.37