Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.88 / $133.82 / $372.15	Professional		$85.88	$133.82	$372.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.51 / $80.70 / $328.28	Professional	26	$66.51	$80.70	$328.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.88 / $56.30 / $139.10	Professional	TC	$27.88	$56.30	$139.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $340.00 / $340.00 / $340.00	Professional		$340.00	$340.00	$340.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $195.00 / $195.00 / $195.00	Professional	26	$195.00	$195.00	$195.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.17 / $165.17 / $329.79	Professional		$79.17	$165.17	$329.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.40 / $101.09 / $215.54	Professional	26	$64.40	$101.09	$215.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.39 / $63.22 / $122.44	Professional	TC	$16.39	$63.22	$122.44
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $140.18 / $341.72	Professional		$100.00	$140.18	$341.72
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.56 / $85.07 / $206.08	Professional	26	$60.56	$85.07	$206.08
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $40.65 / $55.11 / $132.41	Professional	TC	$40.65	$55.11	$132.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.03 / $80.42 / $287.76	Professional		$59.03	$80.42	$287.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.94 / $50.60 / $170.50	Professional	26	$42.94	$50.60	$170.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.90 / $33.20 / $105.97	Professional	TC	$14.90	$33.20	$105.97
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $88.41 / $139.19 / $187.91	Professional		$88.41	$139.19	$187.91
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.73 / $98.20 / $132.57	Professional	26	$70.73	$98.20	$132.57
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.68 / $40.99 / $55.34	Professional	TC	$17.68	$40.99	$55.34
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $118.67 / $118.67 / $118.67	Professional		$118.67	$118.67	$118.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.43 / $135.88 / $238.60	Professional		$112.43	$135.88	$238.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $78.56 / $117.84 / $147.32	Professional	26	$78.56	$117.84	$147.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.29 / $49.06 / $61.49	Professional	TC	$30.29	$49.06	$61.49
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $206.46 / $390.55 / $429.02	Facility	26	$206.46	$390.55	$429.02
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $745.14 / $745.14 / $943.13	Professional		$745.14	$745.14	$943.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $538.00 / $538.00 / $687.38	Professional	26	$538.00	$538.00	$687.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $340.13 / $340.13 / $340.13	Professional	TC	$340.13	$340.13	$340.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.55 / $100.57 / $131.49	Professional		$26.55	$100.57	$131.49
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.78 / $149.07 / $329.17	Professional		$67.78	$149.07	$329.17
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.95 / $51.86 / $228.19	Professional	26	$42.95	$51.86	$228.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $15.82 / $33.28 / $105.97	Professional	TC	$15.82	$33.28	$105.97
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $432.84 / $432.84 / $432.84	Professional		$432.84	$432.84	$432.84
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $332.42 / $332.42 / $332.42	Professional	26	$332.42	$332.42	$332.42
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $100.41 / $100.41 / $100.41	Professional	TC	$100.41	$100.41	$100.41
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $112.58 / $112.58 / $154.79	Professional		$112.58	$112.58	$154.79
United Facility/Professional Professional Modifier Low / Median / High Price $70.59 / $85.62 / $308.22	Professional		$70.59	$85.62	$308.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.57 / $57.56 / $226.54	Professional	26	$49.57	$57.56	$226.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.02 / $28.89 / $88.55	Professional	TC	$16.02	$28.89	$88.55