Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $70.79 / $147.91	Facility	26	$53.70	$70.79	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $194.98 / $954.99	Professional		$154.88	$194.98	$954.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $125.89 / $295.12	Professional	26	$51.29	$125.89	$295.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $128.82 / $512.86	Professional	TC	$100.00	$128.82	$512.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $251.19 / $331.13	Professional		$251.19	$251.19	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $104.71 / $295.12	Professional	26	$91.20	$104.71	$295.12
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $302.00 / $630.96	Professional		$194.98	$302.00	$630.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $85.11 / $173.78	Professional	26	$63.10	$85.11	$173.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $213.80 / $446.68	Professional	TC	$131.83	$213.80	$446.68
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $257.04 / $602.56	Professional		$194.98	$257.04	$602.56
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $81.28 / $190.55	Professional	26	$61.66	$81.28	$190.55
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $173.78 / $407.38	Professional	TC	$131.83	$173.78	$407.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $239.88 / $524.81	Professional		$162.18	$239.88	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $74.13 / $158.49	Professional	26	$51.29	$74.13	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $173.78 / $363.08	Professional	TC	$114.82	$173.78	$363.08
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $229.09 / $251.19	Professional		$154.88	$229.09	$251.19
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $61.66 / $67.61	Professional	26	$47.86	$61.66	$67.61
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $165.96 / $181.97	Professional	TC	$107.15	$165.96	$181.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $223.87 / $426.58	Professional		$173.78	$223.87	$426.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $131.83	Professional	26	$53.70	$70.79	$131.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $173.78 / $316.23	Professional	TC	$128.82	$173.78	$316.23
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $354.81 / $354.81	Facility	26	$354.81	$354.81	$354.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $1,819.70	Professional		$1,819.70	$1,819.70	$1,819.70
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $537.03 / $537.03 / $537.03	Professional	26	$537.03	$537.03	$537.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,258.93 / $1,258.93 / $1,258.93	Professional	TC	$1,258.93	$1,258.93	$1,258.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $109.65 / $194.98	Professional		$66.07	$109.65	$194.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $239.88 / $524.81	Professional		$158.49	$239.88	$524.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $74.13 / $158.49	Professional	26	$51.29	$74.13	$158.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $173.78 / $354.81	Professional	TC	$117.49	$173.78	$354.81
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $602.56 / $602.56	Professional		$602.56	$602.56	$602.56
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Professional	26	$190.55	$190.55	$190.55
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $407.38 / $407.38 / $407.38	Professional	TC	$407.38	$407.38	$407.38
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $257.04 / $426.58	Professional		$186.21	$257.04	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $204.17 / $489.78	Professional		$154.88	$204.17	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $154.88	Professional	26	$46.77	$61.66	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $141.25 / $354.81	Professional	TC	$104.71	$141.25	$354.81