Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.29 / $107.83 / $641.52	Facility	26	$96.29	$107.83	$641.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.15 / $199.16 / $784.94	Professional		$170.15	$199.16	$784.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.84 / $110.56 / $428.85	Professional	26	$94.84	$110.56	$428.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.20 / $79.70 / $150.33	Professional	TC	$68.20	$79.70	$150.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $151.44 / $168.52 / $304.24	Professional		$151.44	$168.52	$304.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $89.48 / $119.63 / $180.94	Professional	26	$89.48	$119.63	$180.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $165.74 / $251.02 / $521.52	Professional		$165.74	$251.02	$521.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.90 / $136.02 / $280.45	Professional	26	$92.90	$136.02	$280.45
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.69 / $114.36 / $241.07	Professional	TC	$69.69	$114.36	$241.07
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $117.53 / $171.29 / $391.62	Professional		$117.53	$171.29	$391.62
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.24 / $112.97 / $210.84	Professional	26	$83.24	$112.97	$210.84
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $76.40 / $100.00 / $185.83	Professional	TC	$76.40	$100.00	$185.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $153.33 / $246.07 / $556.50	Professional		$153.33	$246.07	$556.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.72 / $141.61 / $311.94	Professional	26	$110.72	$141.61	$311.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.06 / $115.64 / $266.02	Professional	TC	$86.06	$115.64	$266.02
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $160.94 / $214.29 / $289.29	Professional		$160.94	$214.29	$289.29
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.52 / $118.21 / $159.58	Professional	26	$88.52	$118.21	$159.58
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.43 / $96.07 / $129.69	Professional	TC	$72.43	$96.07	$129.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $166.17 / $208.24 / $391.29	Professional		$166.17	$208.24	$391.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $97.52 / $119.46 / $213.37	Professional	26	$97.52	$119.46	$213.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.06 / $96.07 / $173.41	Professional	TC	$74.06	$96.07	$173.41
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $239.95 / $467.77 / $514.76	Facility	26	$239.95	$467.77	$514.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,142.65 / $1,142.65 / $1,428.60	Professional		$1,142.65	$1,142.65	$1,428.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $663.65 / $663.65 / $833.40	Professional	26	$663.65	$663.65	$833.40
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $479.00 / $479.00 / $595.20	Professional	TC	$479.00	$479.00	$595.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $244.34	Professional		$32.34	$32.34	$244.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $193.45 / $274.33 / $486.53	Professional		$193.45	$274.33	$486.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $110.85 / $142.53 / $289.48	Professional	26	$110.85	$142.53	$289.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $88.62 / $118.85 / $248.62	Professional	TC	$88.62	$118.85	$248.62
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $635.97 / $635.97 / $635.97	Professional		$635.97	$635.97	$635.97
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $355.22 / $355.22 / $355.22	Professional	26	$355.22	$355.22	$355.22
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $280.74 / $280.74 / $280.74	Professional	TC	$280.74	$280.74	$280.74
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $173.29 / $209.23 / $273.61	Professional		$173.29	$209.23	$273.61
United Facility/Professional Professional Modifier Low / Median / High Price $151.76 / $213.44 / $619.29	Professional		$151.76	$213.44	$619.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.40 / $118.47 / $294.43	Professional	26	$85.40	$118.47	$294.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.52 / $93.60 / $229.46	Professional	TC	$65.52	$93.60	$229.46