Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.40 / $111.75 / $280.55	Professional		$89.40	$111.75	$280.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.02 / $37.99 / $178.10	Professional	26	$27.02	$37.99	$178.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.84 / $64.62 / $206.54	Professional	TC	$46.84	$64.62	$206.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.56 / $70.56 / $70.56	Professional		$70.56	$70.56	$70.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.55 / $58.30 / $173.31	Professional	26	$16.55	$58.30	$173.31
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.50 / $151.62 / $330.00	Professional	TC	$53.50	$151.62	$330.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.42 / $117.25 / $292.55	Professional		$56.42	$117.25	$292.55
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.85 / $52.28 / $103.95	Professional	26	$38.85	$52.28	$103.95
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $14.01 / $66.70 / $184.31	Professional	TC	$14.01	$66.70	$184.31
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $81.72 / $109.09 / $265.93	Professional		$81.72	$109.09	$265.93
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.11 / $53.98 / $130.78	Professional	26	$38.11	$53.98	$130.78
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $43.28 / $55.11 / $134.34	Professional	TC	$43.28	$55.11	$134.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.80 / $77.01 / $259.22	Professional		$50.80	$77.01	$259.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.50 / $23.52 / $91.32	Professional	26	$18.50	$23.52	$91.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.77 / $53.39 / $168.07	Professional	TC	$29.77	$53.39	$168.07
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $56.05 / $189.88 / $256.33	Professional		$56.05	$189.88	$256.33
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.50 / $44.84 / $53.33	Professional	26	$39.50	$44.84	$53.33
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $11.21 / $150.38 / $203.01	Professional	TC	$11.21	$150.38	$203.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $146.79 / $176.63 / $285.43	Professional		$146.79	$176.63	$285.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.60 / $47.40 / $59.27	Professional	26	$31.60	$47.40	$59.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $111.10 / $179.75 / $225.57	Professional	TC	$111.10	$179.75	$225.57
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $83.23 / $173.52 / $173.52	Facility	26	$83.23	$173.52	$173.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $973.09 / $973.09 / $1,210.28	Professional		$973.09	$973.09	$1,210.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $236.03 / $237.42 / $277.27	Professional	26	$236.03	$237.42	$277.27
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $750.23 / $750.23 / $933.00	Professional	TC	$750.23	$750.23	$933.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.20 / $106.77 / $169.32	Professional		$41.20	$106.77	$169.32
Providence Facility/Professional Professional Modifier Low / Median / High Price $52.72 / $128.18 / $403.97	Professional		$52.72	$128.18	$403.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.71 / $24.01 / $100.84	Professional	26	$19.71	$24.01	$100.84
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.76 / $58.26 / $168.07	Professional	TC	$29.76	$58.26	$168.07
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $480.65 / $480.65 / $480.65	Professional		$480.65	$480.65	$480.65
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $137.16 / $137.16 / $137.16	Professional	26	$137.16	$137.16	$137.16
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $343.48 / $343.48 / $343.48	Professional	TC	$343.48	$343.48	$343.48
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $153.58 / $153.58 / $211.18	Professional		$153.58	$153.58	$211.18
United Facility/Professional Professional Modifier Low / Median / High Price $57.99 / $84.03 / $273.14	Professional		$57.99	$84.03	$273.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.52 / $25.45 / $83.22	Professional	26	$22.52	$25.45	$83.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.29 / $58.33 / $316.77	Professional	TC	$34.29	$58.33	$316.77