Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.62 / $106.52 / $398.00	Professional		$92.62	$106.52	$398.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.62 / $79.65 / $140.88	Professional	26	$70.62	$79.65	$140.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $332.74 / $332.74 / $332.74	Professional	52	$332.74	$332.74	$332.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.37 / $26.09 / $50.15	Professional	TC	$18.37	$26.09	$50.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.06 / $90.73 / $178.81	Professional		$85.06	$90.73	$178.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $94.87 / $121.57 / $315.27	Professional		$94.87	$121.57	$315.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.84 / $94.47 / $250.93	Professional	26	$77.84	$94.47	$250.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.19 / $26.26 / $81.92	Professional	TC	$17.19	$26.26	$81.92
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $67.80 / $96.86 / $125.71	Professional		$67.80	$96.86	$125.71
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.64 / $79.48 / $101.75	Professional	26	$55.64	$79.48	$101.75
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $12.16 / $17.37 / $24.31	Professional	TC	$12.16	$17.37	$24.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.86 / $134.15 / $408.48	Professional		$96.86	$134.15	$408.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.15 / $102.87 / $316.80	Professional	26	$74.15	$102.87	$316.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.39 / $34.59 / $105.15	Professional	TC	$19.39	$34.59	$105.15
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $82.13 / $123.20 / $139.83	Professional		$82.13	$123.20	$139.83
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.06 / $87.50 / $96.25	Professional	26	$64.06	$87.50	$96.25
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.07 / $27.11 / $43.58	Professional	TC	$18.07	$27.11	$43.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.99 / $113.41 / $198.47	Professional		$95.99	$113.41	$198.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.72 / $78.75 / $109.38	Professional	26	$70.72	$78.75	$109.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.11 / $35.65 / $48.33	Professional	TC	$29.11	$35.65	$48.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $177.91 / $343.65 / $379.86	Facility	26	$177.91	$343.65	$379.86
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $702.18 / $702.18 / $855.00	Professional		$702.18	$702.18	$855.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $487.97 / $487.97 / $607.73	Professional	26	$487.97	$487.97	$607.73
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $214.27 / $214.27 / $247.28	Professional	TC	$214.27	$214.27	$247.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $96.86 / $140.13 / $305.85	Professional		$96.86	$140.13	$305.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $69.80 / $100.46 / $235.05	Professional	26	$69.80	$100.46	$235.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.77 / $32.31 / $91.69	Professional	TC	$18.77	$32.31	$91.69
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $354.59 / $354.59 / $354.59	Professional		$354.59	$354.59	$354.59
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $261.38 / $261.38 / $261.38	Professional	26	$261.38	$261.38	$261.38
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $93.21 / $93.21 / $93.21	Professional	TC	$93.21	$93.21	$93.21
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $115.66 / $141.36 / $141.36	Professional		$115.66	$141.36	$141.36
United Facility/Professional Professional Modifier Low / Median / High Price $80.06 / $97.28 / $246.02	Professional		$80.06	$97.28	$246.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.02 / $76.31 / $193.33	Professional	26	$61.02	$76.31	$193.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.18 / $23.50 / $71.63	Professional	TC	$16.18	$23.50	$71.63