Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $165.96 / $380.19	Facility	26	$56.23	$165.96	$380.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $436.52 / $1,412.54	Professional		$218.78	$436.52	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $67.61 / $213.80	Professional	26	$52.48	$67.61	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $389.05 / $1,047.13	Professional	TC	$158.49	$389.05	$1,047.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $52.48 / $52.48	Professional	26	$52.48	$52.48	$52.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $169.82 / $169.82	Professional	TC	$169.82	$169.82	$169.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $630.96 / $1,148.15	Professional		$389.05	$630.96	$1,148.15
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $79.43 / $177.83	Professional	26	$51.29	$79.43	$177.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $549.54 / $933.25	Professional	TC	$295.12	$549.54	$933.25
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $380.19 / $812.83	Professional		$257.04	$380.19	$812.83
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $100.00 / $213.80	Professional	26	$70.79	$100.00	$213.80
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $281.84 / $602.56	Professional	TC	$186.21	$281.84	$602.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $416.87 / $870.96	Professional		$204.17	$416.87	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $77.62 / $158.49	Professional	26	$53.70	$77.62	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $346.74 / $741.31	Professional	TC	$154.88	$346.74	$741.31
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $295.12 / $398.11	Professional		$199.53	$295.12	$398.11
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $95.50	Professional	26	$53.70	$70.79	$95.50
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $229.09 / $309.03	Professional	TC	$144.54	$229.09	$309.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $295.12 / $562.34	Professional		$223.87	$295.12	$562.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $83.18 / $141.25	Professional	26	$60.26	$83.18	$141.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $263.03 / $426.58	Professional	TC	$177.83	$263.03	$426.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $562.34 / $562.34 / $562.34	Facility	26	$562.34	$562.34	$562.34
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,388.44 / $3,388.44 / $3,388.44	Professional		$3,388.44	$3,388.44	$3,388.44
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $501.19 / $501.19	Professional	26	$436.52	$501.19	$501.19
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,090.30 / $3,090.30 / $3,090.30	Professional	TC	$3,090.30	$3,090.30	$3,090.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $60.26 / $208.93	Professional		$32.36	$60.26	$208.93
Providence Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $457.09 / $851.14	Professional		$199.53	$457.09	$851.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $75.86 / $158.49	Professional	26	$53.70	$75.86	$158.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $371.54 / $741.31	Professional	TC	$154.88	$371.54	$741.31
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $776.25 / $776.25	Professional		$776.25	$776.25	$776.25
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	26	$204.17	$204.17	$204.17
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $575.44 / $575.44	Professional	TC	$575.44	$575.44	$575.44
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $275.42 / $338.84	Professional		$199.53	$275.42	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $363.08 / $831.76	Professional		$199.53	$363.08	$831.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $64.57 / $154.88	Professional	26	$43.65	$64.57	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $269.15 / $707.95	Professional	TC	$144.54	$269.15	$707.95