Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.22 / $65.90 / $252.00	Professional		$55.22	$65.90	$252.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.17 / $39.43 / $148.87	Professional	26	$31.17	$39.43	$148.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.60 / $25.46 / $51.26	Professional	TC	$21.60	$25.46	$51.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.16 / $61.77 / $333.80	Professional		$52.16	$61.77	$333.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.71 / $67.20 / $184.67	Professional		$50.71	$67.20	$184.67
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.31 / $40.68 / $107.17	Professional	26	$32.31	$40.68	$107.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.39 / $24.11 / $77.48	Professional	TC	$18.39	$24.11	$77.48
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $35.02 / $50.03 / $68.84	Professional		$35.02	$50.03	$68.84
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.76 / $32.52 / $43.78	Professional	26	$22.76	$32.52	$43.78
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $12.25 / $17.50 / $25.07	Professional	TC	$12.25	$17.50	$25.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.60 / $81.81 / $263.20	Professional		$52.60	$81.81	$263.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.08 / $47.87 / $153.94	Professional	26	$33.08	$47.87	$153.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.66 / $34.04 / $109.27	Professional	TC	$19.66	$34.04	$109.27
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $32.42 / $42.85 / $87.62	Professional		$32.42	$42.85	$87.62
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.30 / $33.42 / $50.13	Professional	26	$25.30	$33.42	$50.13
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $7.13 / $9.43 / $41.05	Professional	TC	$7.13	$9.43	$41.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $70.05 / $126.09	Professional		$58.88	$70.05	$126.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.06 / $38.10 / $52.91	Professional	26	$34.06	$38.10	$52.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.42 / $33.59 / $45.54	Professional	TC	$27.42	$33.59	$45.54
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $84.68 / $165.02 / $183.07	Facility	26	$84.68	$165.02	$183.07
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $396.08 / $396.08 / $525.75	Professional		$396.08	$396.08	$525.75
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $347.34 / $347.34 / $347.34	Professional	26	$347.34	$347.34	$347.34
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $166.53 / $166.53 / $233.18	Professional	TC	$166.53	$166.53	$233.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $52.60 / $83.92 / $189.20	Professional		$52.60	$83.92	$189.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.85 / $46.01 / $113.92	Professional	26	$31.85	$46.01	$113.92
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.66 / $32.53 / $84.34	Professional	TC	$19.66	$32.53	$84.34
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $210.61 / $210.61 / $210.61	Professional		$210.61	$210.61	$210.61
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $124.61 / $124.61 / $124.61	Professional	26	$124.61	$124.61	$124.61
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $85.99 / $85.99 / $85.99	Professional	TC	$85.99	$85.99	$85.99
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $72.47 / $88.57 / $88.57	Professional		$72.47	$88.57	$88.57
United Facility/Professional Professional Modifier Low / Median / High Price $42.69 / $57.04 / $162.82	Professional		$42.69	$57.04	$162.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.72 / $34.50 / $94.11	Professional	26	$26.72	$34.50	$94.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.02 / $23.25 / $68.70	Professional	TC	$16.02	$23.25	$68.70