Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.65 / $24.90 / $269.93	Facility	26	$23.65	$24.90	$269.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.29 / $107.75 / $584.00	Professional		$86.29	$107.75	$584.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.42 / $29.83 / $182.27	Professional	26	$23.42	$29.83	$182.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.86 / $73.83 / $721.77	Professional	TC	$62.86	$73.83	$721.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.78 / $70.78 / $271.14	Professional		$70.78	$70.78	$271.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.39 / $42.80 / $53.84	Professional	26	$16.39	$42.80	$53.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.00 / $179.64 / $341.31	Professional		$54.00	$179.64	$341.31
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.69 / $45.89 / $87.12	Professional	26	$14.69	$45.89	$87.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.31 / $133.74 / $254.19	Professional	TC	$39.31	$133.74	$254.19
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $91.86 / $114.83 / $287.13	Professional		$91.86	$114.83	$287.13
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $7.57 / $10.43 / $26.26	Professional	26	$7.57	$10.43	$26.26
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $72.81 / $100.00 / $151.90	Professional	TC	$72.81	$100.00	$151.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.98 / $81.00 / $276.63	Professional		$51.98	$81.00	$276.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.77 / $19.51 / $67.04	Professional	26	$13.77	$19.51	$67.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.86 / $61.25 / $213.65	Professional	TC	$37.86	$61.25	$213.65
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $87.58 / $169.51 / $228.84	Professional		$87.58	$169.51	$228.84
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.39 / $37.17 / $50.18	Professional	26	$18.39	$37.17	$50.18
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.19 / $132.34 / $178.66	Professional	TC	$69.19	$132.34	$178.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.13 / $167.56 / $320.54	Professional		$131.13	$167.56	$320.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.32 / $44.60 / $77.67	Professional	26	$30.32	$44.60	$77.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $97.75 / $155.18 / $259.45	Professional	TC	$97.75	$155.18	$259.45
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $78.48 / $148.36 / $162.63	Facility	26	$78.48	$148.36	$162.63
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $875.57 / $875.57 / $1,079.93	Professional		$875.57	$875.57	$1,079.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $212.17 / $212.17 / $261.23	Professional	26	$212.17	$212.17	$261.23
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $663.40 / $663.40 / $818.70	Professional	TC	$663.40	$663.40	$818.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.21 / $113.08 / $152.29	Professional		$39.21	$113.08	$152.29
Providence Facility/Professional Professional Modifier Low / Median / High Price $53.73 / $134.69 / $365.44	Professional		$53.73	$134.69	$365.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.00 / $20.99 / $97.74	Professional	26	$14.00	$20.99	$97.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $38.40 / $72.65 / $266.04	Professional	TC	$38.40	$72.65	$266.04
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $525.94 / $525.94 / $525.94	Professional		$525.94	$525.94	$525.94
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $131.93 / $131.93 / $131.93	Professional	26	$131.93	$131.93	$131.93
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $394.01 / $394.01 / $394.01	Professional	TC	$394.01	$394.01	$394.01
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $89.33 / $137.11 / $154.25	Professional		$89.33	$137.11	$154.25
United Facility/Professional Professional Modifier Low / Median / High Price $61.85 / $84.23 / $418.41	Professional		$61.85	$84.23	$418.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.80 / $22.87 / $104.47	Professional	26	$16.80	$22.87	$104.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.57 / $67.69 / $302.76	Professional	TC	$44.57	$67.69	$302.76