Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.83 / $87.05 / $299.00	Professional		$55.83	$87.05	$299.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $24.75 / $121.82	Professional	26	$10.00	$24.75	$121.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.95 / $71.42 / $266.92	Professional	TC	$51.95	$71.42	$266.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.08 / $77.61 / $168.72	Professional		$40.08	$77.61	$168.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.79 / $19.47 / $26.64	Professional	26	$5.79	$19.47	$26.64
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $34.29 / $34.29 / $34.29	Professional	TC	$34.29	$34.29	$34.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.80 / $85.99 / $197.45	Professional		$28.80	$85.99	$197.45
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.01 / $15.62 / $31.31	Professional	26	$11.01	$15.62	$31.31
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.76 / $71.47 / $166.18	Professional	TC	$23.76	$71.47	$166.18
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $52.82 / $73.16 / $169.17	Professional		$52.82	$73.16	$169.17
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.54 / $30.86	Professional	26	$7.41	$10.54	$30.86
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $45.40 / $62.62 / $144.52	Professional	TC	$45.40	$62.62	$144.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $162.66 / $162.66 / $162.66	Facility		$162.66	$162.66	$162.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.75 / $46.44 / $153.91	Professional		$35.75	$46.44	$153.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.02 / $7.10 / $24.07	Professional	26	$6.02	$7.10	$24.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.27 / $39.28 / $132.13	Professional	TC	$29.27	$39.28	$132.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $34.26 / $109.71 / $148.11	Professional		$34.26	$109.71	$148.11
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $17.79 / $27.41	Professional	26	$13.18	$17.79	$27.41
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $6.85 / $96.53 / $130.32	Professional	TC	$6.85	$96.53	$130.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $84.15 / $101.74 / $164.57	Professional		$84.15	$101.74	$164.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.54 / $15.82 / $19.79	Professional	26	$10.54	$15.82	$19.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $71.31 / $115.37 / $144.80	Professional	TC	$71.31	$115.37	$144.80
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $179.49 / $372.39 / $444.13	Facility		$179.49	$372.39	$444.13
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $27.59 / $100.00 / $100.00	Facility	26	$27.59	$100.00	$100.00
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $152.59 / $319.41 / $386.32	Facility	TC	$152.59	$319.41	$386.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $514.55 / $514.55 / $692.33	Professional		$514.55	$514.55	$692.33
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.52 / $87.52 / $94.35	Professional	26	$87.52	$87.52	$94.35
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $439.92 / $439.92 / $598.04	Professional	TC	$439.92	$439.92	$598.04
Providence Facility/Professional Facility Modifier Low / Median / High Price $30.33 / $93.24 / $144.21	Facility		$30.33	$93.24	$144.21
Providence Facility/Professional Professional Modifier Low / Median / High Price $35.85 / $89.92 / $214.63	Professional		$35.85	$89.92	$214.63
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $6.13 / $7.56 / $31.32	Professional	26	$6.13	$7.56	$31.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.27 / $45.49 / $160.79	Professional	TC	$29.27	$45.49	$160.79
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $289.58 / $289.58 / $289.58	Professional		$289.58	$289.58	$289.58
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $45.79 / $45.79 / $45.79	Professional	26	$45.79	$45.79	$45.79
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $243.80 / $243.80 / $243.80	Professional	TC	$243.80	$243.80	$243.80
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $88.74 / $88.74 / $122.02	Professional		$88.74	$88.74	$122.02
United Facility/Professional Facility Modifier Low / Median / High Price $16.80 / $16.80 / $16.80	Facility		$16.80	$16.80	$16.80
United Facility/Professional Professional Modifier Low / Median / High Price $41.61 / $46.34 / $168.11	Professional		$41.61	$46.34	$168.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.94 / $7.58 / $28.01	Professional	26	$6.94	$7.58	$28.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.71 / $41.69 / $143.24	Professional	TC	$34.71	$41.69	$143.24