Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $137.41 / $144.66 / $907.71	Facility	26	$137.41	$144.66	$907.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $255.18 / $297.10 / $776.54	Professional		$255.18	$297.10	$776.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.81 / $162.97 / $563.41	Professional	26	$131.81	$162.97	$563.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.37 / $143.25 / $414.02	Professional	TC	$123.37	$143.25	$414.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $305.75 / $516.41 / $703.33	Professional		$305.75	$516.41	$703.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $193.85 / $193.85 / $299.37	Professional	26	$193.85	$193.85	$299.37
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $373.07 / $466.33 / $931.56	Professional		$373.07	$466.33	$931.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $184.90 / $231.12 / $465.81	Professional	26	$184.90	$231.12	$465.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $185.24 / $235.21 / $459.36	Professional	TC	$185.24	$235.21	$459.36
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $220.16 / $322.92 / $786.43	Professional		$220.16	$322.92	$786.43
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $111.05 / $159.68 / $393.43	Professional	26	$111.05	$159.68	$393.43
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $109.11 / $163.24 / $389.75	Professional	TC	$109.11	$163.24	$389.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $253.99 / $372.35 / $844.15	Professional		$253.99	$372.35	$844.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $129.37 / $190.93 / $437.32	Professional	26	$129.37	$190.93	$437.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $124.65 / $181.24 / $425.49	Professional	TC	$124.65	$181.24	$425.49
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $251.13 / $365.68 / $493.67	Professional		$251.13	$365.68	$493.67
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $125.57 / $176.91 / $238.83	Professional	26	$125.57	$176.91	$238.83
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.57 / $188.76 / $254.83	Professional	TC	$125.57	$188.76	$254.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $288.89 / $369.61 / $652.34	Professional		$288.89	$369.61	$652.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $151.93 / $218.78 / $365.24	Professional	26	$151.93	$218.78	$365.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $145.68 / $221.55 / $354.87	Professional	TC	$145.68	$221.55	$354.87
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $357.82 / $769.74 / $769.74	Facility	26	$357.82	$769.74	$769.74
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,788.06 / $1,788.06 / $2,427.08	Professional		$1,788.06	$1,788.06	$2,427.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $948.42 / $948.42 / $1,251.23	Professional	26	$948.42	$948.42	$1,251.23
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $839.64 / $839.64 / $1,175.84	Professional	TC	$839.64	$839.64	$1,175.84
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 $260.20 / $381.03 / $830.23	Professional		$260.20	$381.03	$830.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $132.30 / $192.46 / $415.57	Professional	26	$132.30	$192.46	$415.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $125.75 / $182.48 / $417.05	Professional	TC	$125.75	$182.48	$417.05
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $962.32 / $962.32 / $962.32	Professional		$962.32	$962.32	$962.32
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $503.47 / $503.47 / $503.47	Professional	26	$503.47	$503.47	$503.47
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $458.84 / $458.84 / $458.84	Professional	TC	$458.84	$458.84	$458.84
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $295.69 / $351.58 / $426.92	Professional		$295.69	$351.58	$426.92
United Facility/Professional Professional Modifier Low / Median / High Price $226.50 / $369.91 / $919.18	Professional		$226.50	$369.91	$919.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $119.65 / $196.69 / $439.40	Professional	26	$119.65	$196.69	$439.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $106.85 / $173.22 / $541.67	Professional	TC	$106.85	$173.22	$541.67