Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.03 / $55.83 / $157.94	Professional		$42.03	$55.83	$157.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.96 / $38.40 / $275.87	Professional	26	$27.96	$38.40	$275.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.40 / $21.54 / $63.27	Professional	TC	$12.40	$21.54	$63.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.74 / $112.74 / $112.74	Professional		$112.74	$112.74	$112.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.46 / $61.46 / $69.81	Professional	26	$61.46	$61.46	$69.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.59 / $68.91 / $146.06	Professional		$51.59	$68.91	$146.06
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.93 / $44.69 / $93.30	Professional	26	$33.93	$44.69	$93.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.42 / $23.63 / $49.46	Professional	TC	$17.42	$23.63	$49.46
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $37.97 / $53.35 / $126.41	Professional		$37.97	$53.35	$126.41
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.37 / $33.19 / $94.91	Professional	26	$23.37	$33.19	$94.91
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $14.62 / $20.14 / $52.30	Professional	TC	$14.62	$20.14	$52.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.96 / $36.75 / $120.39	Professional		$27.96	$36.75	$120.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.73 / $22.05 / $77.25	Professional	26	$18.73	$22.05	$77.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $9.13 / $14.57 / $43.85	Professional	TC	$9.13	$14.57	$43.85
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $49.68 / $68.52 / $92.50	Professional		$49.68	$68.52	$92.50
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.74 / $41.90 / $56.57	Professional	26	$39.74	$41.90	$56.57
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $9.94 / $26.62 / $35.94	Professional	TC	$9.94	$26.62	$35.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.68 / $65.68 / $106.31	Professional		$54.68	$65.68	$106.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.52 / $50.28 / $62.87	Professional	26	$33.52	$50.28	$62.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.66 / $31.79 / $39.93	Professional	TC	$19.66	$31.79	$39.93
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $86.13 / $165.02 / $182.16	Facility	26	$86.13	$165.02	$182.16
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $353.10 / $353.10 / $455.70	Professional		$353.10	$353.10	$455.70
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $231.59 / $231.59 / $291.60	Professional	26	$231.59	$231.59	$291.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $121.51 / $121.51 / $164.10	Professional	TC	$121.51	$121.51	$164.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.73 / $43.00 / $53.56	Professional		$17.73	$43.00	$53.56
Providence Facility/Professional Professional Modifier Low / Median / High Price $28.50 / $64.06 / $153.97	Professional		$28.50	$64.06	$153.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.80 / $23.52 / $94.36	Professional	26	$18.80	$23.52	$94.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $9.13 / $14.64 / $44.40	Professional	TC	$9.13	$14.64	$44.40
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $213.69 / $213.69 / $213.69	Professional		$213.69	$213.69	$213.69
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $145.41 / $145.41 / $145.41	Professional	26	$145.41	$145.41	$145.41
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $68.27 / $68.27 / $68.27	Professional	TC	$68.27	$68.27	$68.27
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $55.42 / $55.42 / $76.20	Professional		$55.42	$55.42	$76.20
United Facility/Professional Professional Modifier Low / Median / High Price $33.15 / $36.74 / $127.03	Professional		$33.15	$36.74	$127.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.47 / $24.41 / $114.90	Professional	26	$20.47	$24.41	$114.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.82 / $13.41 / $42.16	Professional	TC	$10.82	$13.41	$42.16