Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.61 / $57.33 / $341.33	Facility	26	$54.61	$57.33	$341.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $156.47 / $179.97 / $952.00	Professional		$156.47	$179.97	$952.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.54 / $60.07 / $297.00	Professional	26	$51.54	$60.07	$297.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $105.47 / $125.35 / $360.80	Professional	TC	$105.47	$125.35	$360.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $176.51 / $176.51 / $176.51	Professional		$176.51	$176.51	$176.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.15 / $74.40 / $125.60	Professional	26	$33.15	$74.40	$125.60
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $193.22 / $267.11 / $514.44	Professional		$193.22	$267.11	$514.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.11 / $77.14 / $159.65	Professional	26	$62.11	$77.14	$159.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $129.03 / $187.90 / $374.34	Professional	TC	$129.03	$187.90	$374.34
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $141.31 / $216.34 / $476.74	Professional		$141.31	$216.34	$476.74
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.77 / $68.70 / $142.31	Professional	26	$56.77	$68.70	$142.31
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $149.43 / $329.55	Professional	TC	$100.00	$149.43	$329.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $152.79 / $237.04 / $525.05	Professional		$152.79	$237.04	$525.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.74 / $72.77 / $161.05	Professional	26	$51.74	$72.77	$161.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.70 / $171.51 / $377.38	Professional	TC	$110.70	$171.51	$377.38
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $155.59 / $226.10 / $305.24	Professional		$155.59	$226.10	$305.24
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.23 / $61.66 / $83.24	Professional	26	$48.23	$61.66	$83.24
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.36 / $164.44 / $221.99	Professional	TC	$107.36	$164.44	$221.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $171.50 / $226.10 / $400.06	Professional		$171.50	$226.10	$400.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.72 / $73.89 / $129.56	Professional	26	$50.72	$73.89	$129.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $126.31 / $182.34 / $309.14	Professional	TC	$126.31	$182.34	$309.14
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $132.57 / $254.13 / $272.41	Facility	26	$132.57	$254.13	$272.41
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,809.00 / $1,809.00 / $1,809.00	Professional		$1,809.00	$1,809.00	$1,809.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $543.00 / $543.00 / $543.00	Professional	26	$543.00	$543.00	$543.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,266.00 / $1,266.00 / $1,266.00	Professional	TC	$1,266.00	$1,266.00	$1,266.00
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 $152.79 / $237.04 / $522.07	Professional		$152.79	$237.04	$522.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.74 / $73.73 / $160.90	Professional	26	$51.74	$73.73	$160.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $110.70 / $174.49 / $377.38	Professional	TC	$110.70	$174.49	$377.38
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $596.66 / $596.66 / $596.66	Professional		$596.66	$596.66	$596.66
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $191.91 / $191.91 / $191.91	Professional	26	$191.91	$191.91	$191.91
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $404.75 / $404.75 / $404.75	Professional	TC	$404.75	$404.75	$404.75
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $182.84 / $251.41 / $431.47	Professional		$182.84	$251.41	$431.47
United Facility/Professional Professional Modifier Low / Median / High Price $153.99 / $203.13 / $602.34	Professional		$153.99	$203.13	$602.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.46 / $63.93 / $164.38	Professional	26	$46.46	$63.93	$164.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.99 / $144.16 / $358.10	Professional	TC	$103.99	$144.16	$358.10