Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.62 / $73.84 / $383.84	Professional		$46.62	$73.84	$383.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.19 / $25.36 / $226.66	Professional	26	$16.19	$25.36	$226.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.45 / $64.67 / $571.69	Professional	TC	$30.45	$64.67	$571.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.25 / $16.25 / $16.25	Professional	26	$16.25	$16.25	$16.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.81 / $127.16 / $254.05	Professional		$97.81	$127.16	$254.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.39 / $39.21 / $78.95	Professional	26	$30.39	$39.21	$78.95
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.42 / $87.64 / $176.05	Professional	TC	$67.42	$87.64	$176.05
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $62.04 / $83.98 / $203.13	Professional		$62.04	$83.98	$203.13
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $5.28 / $7.05 / $11.84	Professional	26	$5.28	$7.05	$11.84
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $53.51 / $71.50 / $100.24	Professional	TC	$53.51	$71.50	$100.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.20 / $69.69 / $221.85	Professional		$39.20	$69.69	$221.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.95 / $18.32 / $58.23	Professional	26	$12.95	$18.32	$58.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.26 / $50.73 / $161.19	Professional	TC	$26.26	$50.73	$161.19
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $65.87 / $171.80 / $231.93	Professional		$65.87	$171.80	$231.93
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.08 / $37.63 / $50.80	Professional	26	$21.08	$37.63	$50.80
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.79 / $134.16 / $181.13	Professional	TC	$44.79	$134.16	$181.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $132.87 / $159.86 / $258.35	Professional		$132.87	$159.86	$258.35
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.10 / $45.16 / $56.46	Professional	26	$30.10	$45.16	$56.46
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $99.10 / $160.30 / $201.26	Professional	TC	$99.10	$160.30	$201.26
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $80.39 / $149.85 / $164.49	Facility	26	$80.39	$149.85	$164.49
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $730.19 / $730.19 / $1,094.09	Professional		$730.19	$730.19	$1,094.09
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $199.12 / $200.25 / $264.08	Professional	26	$199.12	$200.25	$264.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $531.07 / $531.07 / $830.03	Professional	TC	$531.07	$531.07	$830.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.11 / $85.71 / $136.52	Professional		$38.11	$85.71	$136.52
Providence Facility/Professional Professional Modifier Low / Median / High Price $41.59 / $102.31 / $304.81	Professional		$41.59	$102.31	$304.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.40 / $19.11 / $58.53	Professional	26	$13.40	$19.11	$58.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.10 / $53.25 / $169.19	Professional	TC	$27.10	$53.25	$169.19
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $435.82 / $435.82 / $435.82	Professional		$435.82	$435.82	$435.82
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $123.74 / $123.74 / $123.74	Professional	26	$123.74	$123.74	$123.74
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 $138.97 / $138.97 / $191.08	Professional		$138.97	$138.97	$191.08
United Facility/Professional Professional Modifier Low / Median / High Price $46.84 / $75.22 / $247.56	Professional		$46.84	$75.22	$247.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $20.81 / $97.76	Professional	26	$15.49	$20.81	$97.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.92 / $53.64 / $204.77	Professional	TC	$30.92	$53.64	$204.77