Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.76 / $64.43 / $179.11	Professional		$48.76	$64.43	$179.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.34 / $25.46 / $110.40	Professional	26	$20.34	$25.46	$110.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.10 / $38.96 / $155.25	Professional	TC	$31.10	$38.96	$155.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.22 / $39.22 / $39.22	Professional		$39.22	$39.22	$39.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.37 / $28.37 / $47.63	Professional	26	$28.37	$28.37	$47.63
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.65 / $73.63 / $186.75	Professional		$39.65	$73.63	$186.75
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.42 / $35.56 / $76.89	Professional	26	$26.42	$35.56	$76.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $11.30 / $39.94 / $113.28	Professional	TC	$11.30	$39.94	$113.28
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $47.24 / $63.57 / $154.96	Professional		$47.24	$63.57	$154.96
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.24 / $35.42 / $100.00	Professional	26	$25.24	$35.42	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $21.99 / $28.15 / $79.89	Professional	TC	$21.99	$28.15	$79.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.29 / $43.04 / $147.12	Professional		$31.29	$43.04	$147.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.10 / $17.11 / $57.16	Professional	26	$14.10	$17.11	$57.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.37 / $26.31 / $91.55	Professional	TC	$17.37	$26.31	$91.55
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $25.82 / $103.22 / $139.35	Professional		$25.82	$103.22	$139.35
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.66 / $30.87 / $41.67	Professional	26	$20.66	$30.87	$41.67
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $5.16 / $72.34 / $97.67	Professional	TC	$5.16	$72.34	$97.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $80.51 / $95.71 / $156.54	Professional		$80.51	$95.71	$156.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.70 / $37.04 / $46.32	Professional	26	$24.70	$37.04	$46.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $53.46 / $86.60 / $108.53	Professional	TC	$53.46	$86.60	$108.53
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $64.34 / $122.62 / $134.76	Facility	26	$64.34	$122.62	$134.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $424.65 / $424.65 / $668.70	Professional		$424.65	$424.65	$668.70
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $214.00 / $214.00 / $216.60	Professional	26	$214.00	$214.00	$216.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $272.93 / $272.93 / $452.18	Professional	TC	$272.93	$272.93	$452.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.32 / $43.88 / $78.12	Professional		$31.32	$43.88	$78.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $34.39 / $75.56 / $196.51	Professional		$34.39	$75.56	$196.51
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.21 / $17.93 / $74.33	Professional	26	$14.21	$17.93	$74.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $17.30 / $26.67 / $102.15	Professional	TC	$17.30	$26.67	$102.15
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $259.08 / $259.08 / $259.08	Professional		$259.08	$259.08	$259.08
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $106.78 / $106.78 / $106.78	Professional	26	$106.78	$106.78	$106.78
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $152.31 / $152.31 / $152.31	Professional	TC	$152.31	$152.31	$152.31
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $83.48 / $83.48 / $114.79	Professional		$83.48	$83.48	$114.79
United Facility/Professional Professional Modifier Low / Median / High Price $37.39 / $45.20 / $146.66	Professional		$37.39	$45.20	$146.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.34 / $18.97 / $66.20	Professional	26	$16.34	$18.97	$66.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.57 / $27.00 / $89.63	Professional	TC	$20.57	$27.00	$89.63