Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.77 / $135.97 / $417.69	Professional		$89.77	$135.97	$417.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.39 / $51.03 / $230.50	Professional	26	$34.39	$51.03	$230.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.32 / $89.94 / $300.81	Professional	TC	$56.32	$89.94	$300.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.54 / $68.29 / $93.83	Professional	26	$51.54	$68.29	$93.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $136.49 / $198.80 / $393.63	Professional		$136.49	$198.80	$393.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.15 / $75.11 / $148.00	Professional	26	$48.15	$75.11	$148.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $88.34 / $122.32 / $247.42	Professional	TC	$88.34	$122.32	$247.42
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $133.62 / $192.80 / $450.53	Professional		$133.62	$192.80	$450.53
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.24 / $70.23 / $170.50	Professional	26	$51.24	$70.23	$170.50
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $90.17 / $116.28 / $283.45	Professional	TC	$90.17	$116.28	$283.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.72 / $95.89 / $322.07	Professional		$64.72	$95.89	$322.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $32.42 / $116.04	Professional	26	$22.91	$32.42	$116.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.35 / $64.84 / $206.89	Professional	TC	$41.35	$64.84	$206.89
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $80.16 / $148.47 / $200.43	Professional		$80.16	$148.47	$200.43
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.89 / $63.30 / $64.13	Professional	26	$46.89	$63.30	$64.13
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.03 / $101.58 / $137.13	Professional	TC	$16.03	$101.58	$137.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $116.12 / $138.75 / $230.13	Professional		$116.12	$138.75	$230.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.51 / $56.27 / $70.34	Professional	26	$37.51	$56.27	$70.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.04 / $121.40 / $152.37	Professional	TC	$75.04	$121.40	$152.37
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $101.20 / $237.42 / $237.42	Facility	26	$101.20	$237.42	$237.42
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $881.27 / $907.71 / $960.68	Professional		$881.27	$907.71	$960.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $341.88 / $342.38 / $342.38	Professional	26	$341.88	$342.38	$342.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $549.40 / $565.88 / $629.17	Professional	TC	$549.40	$565.88	$629.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.48 / $82.64 / $133.11	Professional		$50.48	$82.64	$133.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $78.06 / $178.99 / $352.12	Professional		$78.06	$178.99	$352.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.89 / $35.45 / $132.50	Professional	26	$24.89	$35.45	$132.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $47.08 / $67.95 / $267.02	Professional	TC	$47.08	$67.95	$267.02
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $482.19 / $482.19 / $482.19	Professional		$482.19	$482.19	$482.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $170.10 / $170.10 / $170.10	Professional	26	$170.10	$170.10	$170.10
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $312.08 / $312.08 / $312.08	Professional	TC	$312.08	$312.08	$312.08
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $120.10 / $120.10 / $165.13	Professional		$120.10	$120.10	$165.13
United Facility/Professional Professional Modifier Low / Median / High Price $77.52 / $93.69 / $327.33	Professional		$77.52	$93.69	$327.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.94 / $34.56 / $120.19	Professional	26	$27.94	$34.56	$120.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.58 / $59.13 / $279.67	Professional	TC	$49.58	$59.13	$279.67