Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.02 / $53.47 / $233.51	Professional		$33.02	$53.47	$233.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.12 / $21.91 / $78.05	Professional	26	$15.12	$21.91	$78.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.97 / $31.57 / $136.53	Professional	TC	$18.97	$31.57	$136.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.75 / $63.75 / $63.75	Professional	26	$63.75	$63.75	$63.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.15 / $63.26 / $157.40	Professional		$35.15	$63.26	$157.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.90 / $30.91 / $67.58	Professional	26	$22.90	$30.91	$67.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $9.73 / $33.74 / $97.13	Professional	TC	$9.73	$33.74	$97.13
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $48.68 / $65.05 / $158.57	Professional		$48.68	$65.05	$158.57
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.25 / $31.12 / $90.36	Professional	26	$22.25	$31.12	$90.36
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $26.26 / $33.54 / $95.21	Professional	TC	$26.26	$33.54	$95.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.32 / $42.02 / $134.72	Professional		$30.32	$42.02	$134.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.66 / $15.00 / $49.71	Professional	26	$12.66	$15.00	$49.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.69 / $27.11 / $91.04	Professional	TC	$17.69	$27.11	$91.04
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $20.66 / $109.37 / $147.65	Professional		$20.66	$109.37	$147.65
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.53 / $28.30 / $38.21	Professional	26	$16.53	$28.30	$38.21
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $4.13 / $81.06 / $109.44	Professional	TC	$4.13	$81.06	$109.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $84.94 / $103.24 / $165.17	Professional		$84.94	$103.24	$165.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.64 / $33.96 / $42.47	Professional	26	$22.64	$33.96	$42.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $59.90 / $97.01 / $121.61	Professional	TC	$59.90	$97.01	$121.61
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $58.48 / $112.04 / $123.31	Facility	26	$58.48	$112.04	$123.31
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $466.08 / $466.08 / $704.18	Professional		$466.08	$466.08	$704.18
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $186.58 / $186.58 / $198.23	Professional	26	$186.58	$186.58	$198.23
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $309.75 / $309.75 / $505.88	Professional	TC	$309.75	$309.75	$505.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.24 / $51.01 / $86.32	Professional		$29.24	$51.01	$86.32
Providence Facility/Professional Professional Modifier Low / Median / High Price $31.31 / $70.59 / $194.79	Professional		$31.31	$70.59	$194.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.74 / $15.77 / $66.92	Professional	26	$12.74	$15.77	$66.92
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $17.69 / $30.32 / $107.21	Professional	TC	$17.69	$30.32	$107.21
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $259.43 / $259.43 / $259.43	Professional		$259.43	$259.43	$259.43
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $96.20 / $96.20 / $96.20	Professional	26	$96.20	$96.20	$96.20
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $163.22 / $163.22 / $163.22	Professional	TC	$163.22	$163.22	$163.22
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $88.46 / $88.46 / $121.63	Professional		$88.46	$88.46	$121.63
United Facility/Professional Professional Modifier Low / Median / High Price $33.65 / $45.20 / $154.44	Professional		$33.65	$45.20	$154.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.56 / $15.81 / $58.43	Professional	26	$14.56	$15.81	$58.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.10 / $31.83 / $108.37	Professional	TC	$19.10	$31.83	$108.37