Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.15 / $36.82 / $225.69	Facility	26	$35.15	$36.82	$225.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.87 / $311.04 / $1,444.00	Professional		$251.87	$311.04	$1,444.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.17 / $46.70 / $172.31	Professional	26	$33.17	$46.70	$172.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.71 / $260.75 / $711.26	Professional	TC	$218.71	$260.75	$711.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $243.90 / $243.90 / $243.90	Professional		$243.90	$243.90	$243.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.15 / $46.44 / $83.11	Professional	26	$34.15	$46.44	$83.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.02 / $337.75 / $728.73	Professional		$234.02	$337.75	$728.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.41 / $51.10 / $105.66	Professional	26	$41.41	$51.10	$105.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $185.36 / $296.91 / $623.96	Professional	TC	$185.36	$296.91	$623.96
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $275.89 / $421.63 / $760.05	Professional		$275.89	$421.63	$760.05
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.13 / $42.53 / $100.00	Professional	26	$36.13	$42.53	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $247.79 / $379.79 / $671.36	Professional	TC	$247.79	$379.79	$671.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $233.78 / $365.52 / $965.04	Professional		$233.78	$365.52	$965.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.77 / $46.83 / $106.75	Professional	26	$33.77	$46.83	$106.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.95 / $331.59 / $889.84	Professional	TC	$194.95	$331.59	$889.84
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $295.67 / $396.30 / $535.01	Professional		$295.67	$396.30	$535.01
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.57 / $40.77 / $55.04	Professional	26	$29.57	$40.77	$55.04
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $266.10 / $355.52 / $479.95	Professional	TC	$266.10	$355.52	$479.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $294.47 / $388.25 / $693.36	Professional		$294.47	$388.25	$693.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $48.84 / $85.65	Professional	26	$33.54	$48.84	$85.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $272.88 / $394.07 / $668.38	Professional	TC	$272.88	$394.07	$668.38
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $168.00 / $180.26	Facility	26	$100.00	$168.00	$180.26
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,023.55 / $2,023.55 / $2,503.19	Professional		$2,023.55	$2,023.55	$2,503.19
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $267.48 / $267.48 / $296.55	Professional	26	$267.48	$267.48	$296.55
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,789.49 / $1,789.49 / $2,206.65	Professional	TC	$1,789.49	$1,789.49	$2,206.65
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 $239.26 / $351.56 / $930.07	Professional		$239.26	$351.56	$930.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.29 / $46.83 / $104.20	Professional	26	$34.29	$46.83	$104.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $193.87 / $328.09 / $889.84	Professional	TC	$193.87	$328.09	$889.84
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,136.04 / $1,136.04 / $1,136.04	Professional		$1,136.04	$1,136.04	$1,136.04
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $126.60 / $126.60 / $126.60	Professional	26	$126.60	$126.60	$126.60
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,009.43 / $1,009.43 / $1,009.43	Professional	TC	$1,009.43	$1,009.43	$1,009.43
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $217.17 / $295.67 / $440.74	Professional		$217.17	$295.67	$440.74
United Facility/Professional Professional Modifier Low / Median / High Price $201.32 / $343.57 / $921.03	Professional		$201.32	$343.57	$921.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.14 / $43.15 / $123.25	Professional	26	$30.14	$43.15	$123.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $171.18 / $295.43 / $977.50	Professional	TC	$171.18	$295.43	$977.50