Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.23 / $111.06 / $696.65	Facility	26	$106.23	$111.06	$696.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.90 / $307.06 / $1,327.52	Professional		$216.90	$307.06	$1,327.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.61 / $115.62 / $428.27	Professional	26	$95.61	$115.62	$428.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.68 / $190.35 / $461.19	Professional	TC	$103.68	$190.35	$461.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $198.01 / $198.01 / $198.01	Professional	26	$198.01	$198.01	$198.01
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $292.69 / $431.83 / $896.70	Professional		$292.69	$431.83	$896.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $104.24 / $143.88 / $291.17	Professional	26	$104.24	$143.88	$291.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $179.01 / $287.39 / $627.28	Professional	TC	$179.01	$287.39	$627.28
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $191.00 / $289.58 / $741.42	Professional		$191.00	$289.58	$741.42
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $145.12 / $352.51	Professional	26	$100.00	$145.12	$352.51
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $145.79 / $375.70	Professional	TC	$100.00	$145.79	$375.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.66 / $129.66 / $129.66	Facility	26	$129.66	$129.66	$129.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $535.29 / $1,337.94	Professional		$275.00	$535.29	$1,337.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.06 / $129.68 / $318.94	Professional	26	$63.06	$129.68	$318.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.07 / $396.25 / $1,016.07	Professional	TC	$199.07	$396.25	$1,016.07
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $276.95 / $373.90 / $476.03	Professional		$276.95	$373.90	$476.03
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.79 / $126.27 / $170.46	Professional	26	$82.79	$126.27	$170.46
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $150.69 / $203.43 / $380.82	Professional	TC	$150.69	$203.43	$380.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $374.69 / $538.61 / $909.70	Professional		$374.69	$538.61	$909.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $111.83 / $151.52 / $237.39	Professional	26	$111.83	$151.52	$237.39
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $321.20 / $481.82 / $781.29	Professional	TC	$321.20	$481.82	$781.29
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,043.04 / $1,043.04 / $1,061.59	Facility	26	$1,043.04	$1,043.04	$1,061.59
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,850.25 / $1,915.39 / $1,992.01	Professional		$1,850.25	$1,915.39	$1,992.01
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $717.76 / $717.76 / $918.38	Professional	26	$717.76	$717.76	$918.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,344.20 / $1,435.54 / $1,492.96	Professional	TC	$1,344.20	$1,435.54	$1,492.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $295.63	Professional		$32.34	$32.34	$295.63
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $129.66 / $129.66 / $129.66	Facility	26	$129.66	$129.66	$129.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $275.20 / $604.27 / $1,263.35	Professional		$275.20	$604.27	$1,263.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.06 / $123.79 / $304.45	Professional	26	$63.06	$123.79	$304.45
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $193.67 / $375.51 / $992.46	Professional	TC	$193.67	$375.51	$992.46
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,596.42 / $1,596.42 / $1,596.42	Professional		$1,596.42	$1,596.42	$1,596.42
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $390.57 / $390.57 / $390.57	Professional	26	$390.57	$390.57	$390.57
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,205.83 / $1,205.83 / $1,205.83	Professional	TC	$1,205.83	$1,205.83	$1,205.83
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $223.94 / $307.92 / $703.69	Professional		$223.94	$307.92	$703.69
United Facility/Professional Professional Modifier Low / Median / High Price $320.58 / $485.04 / $1,214.84	Professional		$320.58	$485.04	$1,214.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.97 / $122.93 / $302.33	Professional	26	$86.97	$122.93	$302.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $233.61 / $362.34 / $956.28	Professional	TC	$233.61	$362.34	$956.28