Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $302.00 / $302.00 / $302.00	Facility	TC	$302.00	$302.00	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $125.89 / $457.09	Professional		$67.61	$125.89	$457.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $75.86 / $354.81	Professional	26	$28.18	$75.86	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $79.43 / $562.34	Professional	TC	$51.29	$79.43	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $112.20 / $446.68	Professional		$61.66	$112.20	$446.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $38.90 / $169.82	Professional	26	$16.22	$38.90	$169.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $75.86 / $354.81	Professional	TC	$45.71	$75.86	$354.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $112.20 / $346.74	Professional		$60.26	$112.20	$346.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $57.54 / $117.49	Professional	26	$39.81	$57.54	$117.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $63.10 / $223.87	Professional	TC	$15.85	$63.10	$223.87
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $114.82 / $257.04	Professional		$87.10	$114.82	$257.04
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $58.88 / $131.83	Professional	26	$45.71	$58.88	$131.83
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $56.23 / $123.03	Professional	TC	$43.65	$56.23	$123.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Facility		$190.55	$190.55	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $67.61 / $204.17	Professional		$47.86	$67.61	$204.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $23.44 / $77.62	Professional	26	$18.62	$23.44	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $45.71 / $141.25	Professional	TC	$28.18	$45.71	$141.25
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $147.91 / $199.53	Professional		$53.70	$147.91	$199.53
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $42.66 / $52.48	Professional	26	$38.90	$42.66	$52.48
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $109.65 / $147.91	Professional	TC	$10.72	$109.65	$147.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $138.04 / $223.87	Professional		$114.82	$138.04	$223.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $44.67 / $57.54	Professional	26	$30.90	$44.67	$57.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $120.23 / $162.18	Professional	TC	$81.28	$120.23	$162.18
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $645.65 / $645.65	Facility		$645.65	$645.65	$645.65
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $436.52 / $436.52 / $436.52	Facility	TC	$436.52	$436.52	$436.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $933.25 / $933.25	Professional		$151.36	$933.25	$933.25
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $269.15 / $275.42	Professional	26	$269.15	$269.15	$275.42
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $676.08 / $676.08	Professional	TC	$426.58	$676.08	$676.08
Providence Facility/Professional Facility Modifier Low / Median / High Price $79.43 / $131.83 / $218.78	Facility		$79.43	$131.83	$218.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $91.20 / $302.00	Professional		$51.29	$91.20	$302.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $28.18 / $100.00	Professional	26	$19.05	$28.18	$100.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $46.77 / $144.54	Professional	TC	$28.18	$46.77	$144.54
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $398.11 / $398.11	Professional		$398.11	$398.11	$398.11
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	26	$134.90	$134.90	$134.90
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $263.03 / $263.03	Professional	TC	$263.03	$263.03	$263.03
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $165.96	Professional		$120.23	$120.23	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $67.61 / $275.42	Professional		$57.54	$67.61	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $25.12 / $89.13	Professional	26	$21.88	$25.12	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $45.71 / $186.21	Professional	TC	$34.67	$45.71	$186.21