Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $177.83 / $912.01	Facility	26	$138.04	$177.83	$912.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $323.59 / $1,202.26	Professional		$257.04	$323.59	$1,202.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $194.98 / $562.34	Professional	26	$131.83	$194.98	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $162.18 / $602.56	Professional	TC	$123.03	$162.18	$602.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $524.81 / $707.95	Professional		$524.81	$524.81	$707.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $257.04 / $371.54	Professional	26	$154.88	$257.04	$371.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $512.86 / $1,000.00	Professional		$380.19	$512.86	$1,000.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $257.04 / $501.19	Professional	26	$190.55	$257.04	$501.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $257.04 / $512.86	Professional	TC	$194.98	$257.04	$512.86
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $416.87 / $933.25	Professional		$281.84	$416.87	$933.25
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $208.93 / $457.09	Professional	26	$144.54	$208.93	$457.09
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $208.93 / $457.09	Professional	TC	$141.25	$208.93	$457.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $371.54 / $776.25	Professional		$251.19	$371.54	$776.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $190.55 / $398.11	Professional	26	$131.83	$190.55	$398.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $181.97 / $380.19	Professional	TC	$125.89	$181.97	$380.19
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $371.54 / $501.19	Professional		$251.19	$371.54	$501.19
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $181.97 / $245.47	Professional	26	$125.89	$181.97	$245.47
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $194.98 / $263.03	Professional	TC	$125.89	$194.98	$263.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $371.54 / $660.69	Professional		$288.40	$371.54	$660.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $213.80 / $338.84	Professional	26	$154.88	$213.80	$338.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $223.87 / $371.54	Professional	TC	$151.36	$223.87	$371.54
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $954.99 / $954.99 / $954.99	Facility	26	$954.99	$954.99	$954.99
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $2,454.71 / $2,454.71	Professional		$1,778.28	$2,454.71	$2,454.71
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $954.99 / $1,258.93 / $1,258.93	Professional	26	$954.99	$1,258.93	$1,258.93
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $831.76 / $1,174.90 / $1,174.90	Professional	TC	$831.76	$1,174.90	$1,174.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $123.03 / $323.59	Professional		$32.36	$123.03	$323.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $371.54 / $741.31	Professional		$251.19	$371.54	$741.31
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $190.55 / $398.11	Professional	26	$131.83	$190.55	$398.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $181.97 / $380.19	Professional	TC	$125.89	$181.97	$380.19
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $954.99 / $954.99	Professional		$954.99	$954.99	$954.99
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $501.19 / $501.19 / $501.19	Professional	26	$501.19	$501.19	$501.19
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $457.09 / $457.09	Professional	TC	$457.09	$457.09	$457.09
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $346.74 / $426.58	Professional		$251.19	$346.74	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $371.54 / $724.44	Professional		$229.09	$371.54	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $194.98 / $380.19	Professional	26	$120.23	$194.98	$380.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $173.78 / $363.08	Professional	TC	$107.15	$173.78	$363.08