Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.27 / $34.35 / $205.67	Facility	26	$31.27	$34.35	$205.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $98.92 / $352.00	Professional		$64.31	$98.92	$352.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.88 / $34.82 / $136.19	Professional	26	$29.88	$34.82	$136.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.03 / $58.97 / $117.35	Professional	TC	$33.03	$58.97	$117.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.32 / $101.27 / $102.20	Professional		$85.32	$101.27	$102.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.53 / $33.28 / $69.41	Professional	26	$29.53	$33.28	$69.41
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.77 / $82.75 / $158.86	Professional		$59.77	$82.75	$158.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.34 / $42.82 / $84.02	Professional	26	$33.34	$42.82	$84.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.14 / $33.35 / $95.63	Professional	TC	$18.14	$33.35	$95.63
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $45.90 / $59.76 / $145.50	Professional		$45.90	$59.76	$145.50
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.21 / $30.63 / $76.05	Professional	26	$22.21	$30.63	$76.05
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $15.95 / $21.16 / $65.66	Professional	TC	$15.95	$21.16	$65.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.63 / $107.08 / $267.38	Professional		$54.63	$107.08	$267.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.31 / $44.13 / $98.85	Professional	26	$34.31	$44.13	$98.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.38 / $70.45 / $187.32	Professional	TC	$20.38	$70.45	$187.32
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $22.29 / $28.27 / $177.28	Professional		$22.29	$28.27	$177.28
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.72 / $21.20 / $51.91	Professional	26	$16.72	$21.20	$51.91
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $5.57 / $7.07 / $125.36	Professional	TC	$5.57	$7.07	$125.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $96.53 / $124.92 / $223.24	Professional		$96.53	$124.92	$223.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $38.85 / $69.40	Professional	26	$31.76	$38.85	$69.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $71.59 / $92.86 / $167.61	Professional	TC	$71.59	$92.86	$167.61
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $78.13 / $152.90 / $167.77	Facility	26	$78.13	$152.90	$167.77
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $687.40 / $687.40 / $848.78	Professional		$687.40	$687.40	$848.78
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $224.56 / $224.56 / $273.38	Professional	26	$224.56	$224.56	$273.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $472.45 / $472.45 / $575.40	Professional	TC	$472.45	$472.45	$575.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $142.60	Professional		$32.34	$32.34	$142.60
Providence Facility/Professional Professional Modifier Low / Median / High Price $62.66 / $138.43 / $279.70	Professional		$62.66	$138.43	$279.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.31 / $44.30 / $92.29	Professional	26	$34.31	$44.30	$92.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.38 / $69.03 / $156.19	Professional	TC	$20.38	$69.03	$156.19
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $314.27 / $314.27 / $314.27	Professional		$314.27	$314.27	$314.27
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $114.08 / $114.08 / $114.08	Professional	26	$114.08	$114.08	$114.08
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $200.20 / $200.20 / $200.20	Professional	TC	$200.20	$200.20	$200.20
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $28.27 / $54.35 / $146.03	Professional		$28.27	$54.35	$146.03
United Facility/Professional Professional Modifier Low / Median / High Price $55.54 / $88.84 / $239.77	Professional		$55.54	$88.84	$239.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.68 / $37.61 / $96.52	Professional	26	$27.68	$37.61	$96.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.38 / $56.78 / $176.95	Professional	TC	$22.38	$56.78	$176.95