Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.21 / $49.48 / $246.00	Professional		$42.21	$49.48	$246.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.55 / $33.72 / $151.07	Professional	26	$25.55	$33.72	$151.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.97 / $21.35 / $96.47	Professional	TC	$14.97	$21.35	$96.47
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.93 / $30.78 / $49.24	Professional		$28.93	$30.78	$49.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.63 / $67.02 / $136.00	Professional	26	$16.63	$67.02	$136.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $116.00 / $116.00 / $116.00	Professional	TC	$116.00	$116.00	$116.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.84 / $66.09 / $137.72	Professional		$50.84	$66.09	$137.72
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.76 / $41.16 / $94.54	Professional	26	$28.76	$41.16	$94.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $15.65 / $27.00 / $57.94	Professional	TC	$15.65	$27.00	$57.94
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $44.15 / $59.89 / $145.99	Professional		$44.15	$59.89	$145.99
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.12 / $38.03 / $100.00	Professional	26	$27.12	$38.03	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $17.03 / $21.86 / $60.72	Professional	TC	$17.03	$21.86	$60.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.19 / $33.89 / $111.52	Professional		$27.19	$33.89	$111.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.27 / $20.70 / $72.51	Professional	26	$16.27	$20.70	$72.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.25 / $13.47 / $44.14	Professional	TC	$10.25	$13.47	$44.14
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $28.29 / $69.55 / $93.89	Professional		$28.29	$69.55	$93.89
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.63 / $39.57 / $53.42	Professional	26	$22.63	$39.57	$53.42
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $5.66 / $29.98 / $40.47	Professional	TC	$5.66	$29.98	$40.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $55.40 / $66.54 / $107.71	Professional		$55.40	$66.54	$107.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.66 / $47.48 / $59.37	Professional	26	$31.66	$47.48	$59.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.16 / $35.90 / $44.97	Professional	TC	$22.16	$35.90	$44.97
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $81.38 / $155.94 / $172.05	Facility	26	$81.38	$155.94	$172.05
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $473.28 / $473.28 / $473.28	Professional		$473.28	$473.28	$473.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $346.00 / $346.00 / $346.00	Professional	26	$346.00	$346.00	$346.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $330.22 / $330.22 / $330.22	Professional	TC	$330.22	$330.22	$330.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.41 / $40.64 / $63.49	Professional		$19.41	$40.64	$63.49
Providence Facility/Professional Professional Modifier Low / Median / High Price $27.72 / $63.01 / $151.05	Professional		$27.72	$63.01	$151.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.27 / $22.02 / $80.69	Professional	26	$16.27	$22.02	$80.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $10.57 / $14.57 / $56.52	Professional	TC	$10.57	$14.57	$56.52
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $210.56 / $210.56 / $210.56	Professional		$210.56	$210.56	$210.56
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $137.44 / $137.44 / $137.44	Professional	26	$137.44	$137.44	$137.44
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $73.09 / $73.09 / $73.09	Professional	TC	$73.09	$73.09	$73.09
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $56.25 / $56.25 / $77.34	Professional		$56.25	$56.25	$77.34
United Facility/Professional Professional Modifier Low / Median / High Price $31.66 / $36.79 / $145.10	Professional		$31.66	$36.79	$145.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.14 / $22.82 / $80.98	Professional	26	$18.14	$22.82	$80.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.69 / $13.72 / $50.98	Professional	TC	$11.69	$13.72	$50.98