Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.21 / $22.37 / $141.13	Facility	26	$21.21	$22.37	$141.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $211.47 / $258.89 / $1,193.00	Professional		$211.47	$258.89	$1,193.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.60 / $23.70 / $93.06	Professional	26	$20.60	$23.70	$93.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $189.20 / $218.05 / $608.91	Professional	TC	$189.20	$218.05	$608.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.33 / $43.33 / $43.33	Professional	26	$43.33	$43.33	$43.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $243.36 / $357.93 / $726.09	Professional		$243.36	$357.93	$726.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.16 / $31.04 / $62.95	Professional	26	$24.16	$31.04	$62.95
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $219.25 / $327.02 / $663.42	Professional	TC	$219.25	$327.02	$663.42
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $199.23 / $308.70 / $700.32	Professional		$199.23	$308.70	$700.32
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.26 / $28.51 / $72.48	Professional	26	$24.26	$28.51	$72.48
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $180.36 / $280.86 / $633.35	Professional	TC	$180.36	$280.86	$633.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.50 / $311.22 / $718.81	Professional		$208.50	$311.22	$718.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.14 / $30.68 / $67.56	Professional	26	$21.14	$30.68	$67.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.37 / $294.93 / $666.43	Professional	TC	$199.37	$294.93	$666.43
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $213.50 / $286.97 / $387.41	Professional		$213.50	$286.97	$387.41
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.22 / $25.69 / $34.68	Professional	26	$19.22	$25.69	$34.68
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $194.29 / $261.29 / $352.74	Professional	TC	$194.29	$261.29	$352.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $212.90 / $283.87 / $537.09	Professional		$212.90	$283.87	$537.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.11 / $30.74 / $53.91	Professional	26	$21.11	$30.74	$53.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $200.57 / $289.63 / $491.23	Professional	TC	$200.57	$289.63	$491.23
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $55.06 / $104.46 / $113.34	Facility	26	$55.06	$104.46	$113.34
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,459.76 / $1,459.76 / $1,808.10	Professional		$1,459.76	$1,459.76	$1,808.10
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $147.05 / $147.05 / $185.33	Professional	26	$147.05	$147.05	$185.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,312.71 / $1,312.71 / $1,622.78	Professional	TC	$1,312.71	$1,312.71	$1,622.78
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 $208.50 / $310.81 / $716.31	Professional		$208.50	$310.81	$716.31
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.14 / $30.68 / $66.36	Professional	26	$21.14	$30.68	$66.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $209.00 / $296.14 / $666.43	Professional	TC	$209.00	$296.14	$666.43
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $818.27 / $818.27 / $818.27	Professional		$818.27	$818.27	$818.27
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $79.31 / $79.31 / $79.31	Professional	26	$79.31	$79.31	$79.31
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $738.95 / $738.95 / $738.95	Professional	TC	$738.95	$738.95	$738.95
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $232.12 / $298.89 / $362.95	Professional		$232.12	$298.89	$362.95
United Facility/Professional Professional Modifier Low / Median / High Price $202.63 / $256.68 / $834.82	Professional		$202.63	$256.68	$834.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $24.90 / $87.06	Professional	26	$19.89	$24.90	$87.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $182.74 / $255.85 / $753.56	Professional	TC	$182.74	$255.85	$753.56