Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.56 / $75.02 / $445.41	Facility	26	$70.56	$75.02	$445.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $342.85 / $428.51 / $2,337.00	Professional		$342.85	$428.51	$2,337.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.56 / $81.62 / $315.56	Professional	26	$68.56	$81.62	$315.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $274.27 / $310.45 / $1,097.89	Professional	TC	$274.27	$310.45	$1,097.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $320.95 / $320.95 / $320.95	Professional		$320.95	$320.95	$320.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $74.95 / $119.82 / $322.00	Professional	26	$74.95	$119.82	$322.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $444.42 / $590.63 / $1,188.43	Professional		$444.42	$590.63	$1,188.43
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.68 / $104.07 / $209.42	Professional	26	$80.68	$104.07	$209.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $363.52 / $472.56 / $979.01	Professional	TC	$363.52	$472.56	$979.01
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $339.56 / $523.66 / $1,264.52	Professional		$339.56	$523.66	$1,264.52
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $75.84 / $89.18 / $208.68	Professional	26	$75.84	$89.18	$208.68
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $280.57 / $436.88 / $1,050.21	Professional	TC	$280.57	$436.88	$1,050.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $344.48 / $563.96 / $1,331.36	Professional		$344.48	$563.96	$1,331.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.34 / $98.10 / $212.34	Professional	26	$66.34	$98.10	$212.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $322.50 / $495.99 / $1,124.77	Professional	TC	$322.50	$495.99	$1,124.77
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $364.92 / $515.04 / $695.32	Professional		$364.92	$515.04	$695.32
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.04 / $80.58 / $108.78	Professional	26	$62.04	$80.58	$108.78
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $302.88 / $434.47 / $586.53	Professional	TC	$302.88	$434.47	$586.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $385.15 / $507.22 / $940.00	Professional		$385.15	$507.22	$940.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $66.30 / $96.66 / $169.44	Professional	26	$66.30	$96.66	$169.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $333.42 / $481.54 / $816.80	Professional	TC	$333.42	$481.54	$816.80
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $173.90 / $328.49 / $356.06	Facility	26	$173.90	$328.49	$356.06
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,692.02 / $2,692.02 / $3,274.95	Professional		$2,692.02	$2,692.02	$3,274.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $462.06 / $462.06 / $581.78	Professional	26	$462.06	$462.06	$581.78
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,230.02 / $2,230.02 / $2,693.18	Professional	TC	$2,230.02	$2,230.02	$2,693.18
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 $344.48 / $553.94 / $1,303.82	Professional		$344.48	$553.94	$1,303.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.34 / $98.10 / $207.13	Professional	26	$66.34	$98.10	$207.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $322.50 / $503.91 / $1,118.27	Professional	TC	$322.50	$503.91	$1,118.27
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,519.80 / $1,519.80 / $1,519.80	Professional		$1,519.80	$1,519.80	$1,519.80
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $250.70 / $250.70 / $250.70	Professional	26	$250.70	$250.70	$250.70
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,269.08 / $1,269.08 / $1,269.08	Professional	TC	$1,269.08	$1,269.08	$1,269.08
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $416.59 / $510.89 / $620.37	Professional		$416.59	$510.89	$620.37
United Facility/Professional Professional Modifier Low / Median / High Price $300.33 / $470.60 / $1,377.88	Professional		$300.33	$470.60	$1,377.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.37 / $84.81 / $214.36	Professional	26	$65.37	$84.81	$214.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $236.73 / $381.82 / $1,160.19	Professional	TC	$236.73	$381.82	$1,160.19