Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.61 / $19.57 / $121.36	Facility	26	$18.61	$19.57	$121.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.06 / $84.22 / $309.82	Professional		$68.06	$84.22	$309.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.84 / $24.14 / $78.00	Professional	26	$17.84	$24.14	$78.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.22 / $56.16 / $103.58	Professional	TC	$50.22	$56.16	$103.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $68.20 / $79.06 / $158.56	Professional		$68.20	$79.06	$158.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.16 / $42.65 / $103.40	Professional	26	$26.16	$42.65	$103.40
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.86 / $177.74 / $307.38	Professional		$79.86	$177.74	$307.38
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.64 / $43.76 / $78.56	Professional	26	$21.64	$43.76	$78.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.22 / $132.86 / $232.51	Professional	TC	$58.22	$132.86	$232.51
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $72.00 / $90.98 / $207.57	Professional		$72.00	$90.98	$207.57
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.67 / $21.30 / $47.73	Professional	26	$15.67	$21.30	$47.73
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $47.33 / $61.68 / $100.93	Professional	TC	$47.33	$61.68	$100.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.55 / $67.55 / $73.59	Professional		$67.55	$67.55	$73.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $18.45 / $23.48	Professional	26	$18.45	$18.45	$23.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $49.10 / $49.10	Professional	TC	$49.10	$49.10	$49.10
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $67.50 / $99.07 / $133.74	Professional		$67.50	$99.07	$133.74
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.88 / $23.65 / $31.93	Professional	26	$16.88	$23.65	$31.93
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.63 / $75.42 / $101.82	Professional	TC	$50.63	$75.42	$101.82
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $51.74 / $54.00 / $54.00	Professional	26	$51.74	$54.00	$54.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.93 / $99.31 / $186.25	Professional		$75.93	$99.31	$186.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.32 / $29.28 / $48.90	Professional	26	$20.32	$29.28	$48.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $58.16 / $88.48 / $141.79	Professional	TC	$58.16	$88.48	$141.79
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $39.24 / $104.06 / $104.06	Facility	26	$39.24	$104.06	$104.06
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $468.55 / $468.55 / $636.15	Professional		$468.55	$468.55	$636.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $126.27 / $126.27 / $168.23	Professional	26	$126.27	$126.27	$168.23
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $342.28 / $342.28 / $467.93	Professional	TC	$342.28	$342.28	$467.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.55 / $67.55 / $157.32	Professional		$67.55	$67.55	$157.32
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $18.45 / $18.45	Professional	26	$18.45	$18.45	$18.45
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $49.10 / $49.10	Professional	TC	$49.10	$49.10	$49.10
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $251.78 / $251.78 / $251.78	Professional		$251.78	$251.78	$251.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $67.20 / $67.20 / $67.20	Professional	26	$67.20	$67.20	$67.20
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $184.57 / $184.57 / $184.57	Professional	TC	$184.57	$184.57	$184.57
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $80.13 / $94.50 / $114.75	Professional		$80.13	$94.50	$114.75
United Facility/Professional Professional Modifier Low / Median / High Price $81.84 / $96.34 / $233.07	Professional		$81.84	$96.34	$233.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.93 / $26.16 / $65.72	Professional	26	$14.93	$26.16	$65.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.49 / $77.00 / $186.84	Professional	TC	$59.49	$77.00	$186.84