Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.25 / $91.65 / $269.11	Professional		$55.25	$91.65	$269.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.20 / $20.76 / $76.28	Professional	26	$14.20	$20.76	$76.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.75 / $71.87 / $187.20	Professional	TC	$40.75	$71.87	$187.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.97 / $41.97 / $41.97	Professional		$41.97	$41.97	$41.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.83 / $108.34 / $249.04	Professional		$44.83	$108.34	$249.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.53 / $32.72 / $65.75	Professional	26	$21.53	$32.72	$65.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.34 / $78.51 / $190.66	Professional	TC	$25.34	$78.51	$190.66
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $82.67 / $113.24 / $271.88	Professional		$82.67	$113.24	$271.88
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.11 / $28.38 / $78.47	Professional	26	$20.11	$28.38	$78.47
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $62.56 / $84.76 / $202.87	Professional	TC	$62.56	$84.76	$202.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.18 / $55.37 / $194.30	Professional		$42.18	$55.37	$194.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $13.40 / $44.52	Professional	26	$11.23	$13.40	$44.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.19 / $41.81 / $154.11	Professional	TC	$29.19	$41.81	$154.11
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $43.23 / $112.20 / $151.47	Professional		$43.23	$112.20	$151.47
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.49 / $29.01 / $34.58	Professional	26	$21.49	$29.01	$34.58
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $8.65 / $90.71 / $122.46	Professional	TC	$8.65	$90.71	$122.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $86.90 / $104.42 / $173.91	Professional		$86.90	$104.42	$173.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.19 / $25.79 / $32.25	Professional	26	$17.19	$25.79	$32.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $67.02 / $108.52 / $136.07	Professional	TC	$67.02	$108.52	$136.07
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $47.20 / $100.00 / $100.00	Facility	26	$47.20	$100.00	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $626.79 / $626.79 / $719.55	Professional		$626.79	$626.79	$719.55
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $171.71 / $171.71 / $171.71	Professional	26	$171.71	$171.71	$171.71
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $496.32 / $496.32 / $565.28	Professional	TC	$496.32	$496.32	$565.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.91 / $64.28 / $101.04	Professional		$23.91	$64.28	$101.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $42.74 / $107.22 / $261.52	Professional		$42.74	$107.22	$261.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.32 / $14.26 / $60.56	Professional	26	$11.32	$14.26	$60.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.05 / $46.87 / $171.51	Professional	TC	$30.05	$46.87	$171.51
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $368.96 / $368.96 / $368.96	Professional		$368.96	$368.96	$368.96
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $84.19 / $84.19 / $84.19	Professional	26	$84.19	$84.19	$84.19
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $284.76 / $284.76 / $284.76	Professional	TC	$284.76	$284.76	$284.76
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $90.74 / $90.74 / $124.77	Professional		$90.74	$90.74	$124.77
United Facility/Professional Professional Modifier Low / Median / High Price $47.99 / $59.11 / $211.78	Professional		$47.99	$59.11	$211.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.07 / $14.60 / $49.47	Professional	26	$13.07	$14.60	$49.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.92 / $48.32 / $163.36	Professional	TC	$34.92	$48.32	$163.36