Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.32 / $98.61 / $98.61	Facility	26	$93.32	$98.61	$98.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $293.74 / $356.73 / $846.41	Professional		$293.74	$356.73	$846.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.57 / $102.65 / $360.87	Professional	26	$89.57	$102.65	$360.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $204.15 / $241.02 / $463.70	Professional	TC	$204.15	$241.02	$463.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $174.54 / $174.54 / $174.54	Professional	26	$174.54	$174.54	$174.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $437.06 / $546.32 / $1,076.95	Professional		$437.06	$546.32	$1,076.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $125.41 / $156.76 / $316.12	Professional	26	$125.41	$156.76	$316.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $300.30 / $389.56 / $761.13	Professional	TC	$300.30	$389.56	$761.13
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $257.17 / $380.31 / $918.66	Professional		$257.17	$380.31	$918.66
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $97.70 / $116.49 / $287.45	Professional	26	$97.70	$116.49	$287.45
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $176.34 / $254.15 / $631.23	Professional	TC	$176.34	$254.15	$631.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $293.64 / $438.68 / $1,024.25	Professional		$293.64	$438.68	$1,024.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.71 / $129.62 / $295.27	Professional	26	$87.71	$129.62	$295.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $209.27 / $313.02 / $736.11	Professional	TC	$209.27	$313.02	$736.11
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $290.89 / $456.83 / $616.72	Professional		$290.89	$456.83	$616.72
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.27 / $119.21 / $160.93	Professional	26	$87.27	$119.21	$160.93
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $203.62 / $337.62 / $455.79	Professional	TC	$203.62	$337.62	$455.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $350.50 / $456.83 / $865.92	Professional		$350.50	$456.83	$865.92
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $103.41 / $149.01 / $259.88	Professional	26	$103.41	$149.01	$259.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $260.41 / $405.14 / $736.01	Professional	TC	$260.41	$405.14	$736.01
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $240.70 / $517.75 / $517.75	Facility	26	$240.70	$517.75	$517.75
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,193.48 / $2,193.48 / $2,933.78	Professional		$2,193.48	$2,193.48	$2,933.78
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $640.52 / $640.52 / $837.45	Professional	26	$640.52	$640.52	$837.45
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,552.95 / $1,552.95 / $2,096.33	Professional	TC	$1,552.95	$1,552.95	$2,096.33
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 $321.62 / $454.54 / $976.25	Professional		$321.62	$454.54	$976.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $89.34 / $129.78 / $279.88	Professional	26	$89.34	$129.78	$279.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $222.49 / $317.42 / $703.47	Professional	TC	$222.49	$317.42	$703.47
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,126.24 / $1,126.24 / $1,126.24	Professional		$1,126.24	$1,126.24	$1,126.24
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $339.20 / $339.20 / $339.20	Professional	26	$339.20	$339.20	$339.20
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $787.03 / $787.03 / $787.03	Professional	TC	$787.03	$787.03	$787.03
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $369.48 / $415.67 / $508.04	Professional		$369.48	$415.67	$508.04
United Facility/Professional Professional Modifier Low / Median / High Price $257.49 / $429.01 / $1,096.89	Professional		$257.49	$429.01	$1,096.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.00 / $132.63 / $299.43	Professional	26	$81.00	$132.63	$299.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $176.50 / $296.38 / $719.65	Professional	TC	$176.50	$296.38	$719.65