Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.41 / $48.30 / $291.83	Facility	26	$45.41	$48.30	$291.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $254.75 / $322.95 / $1,627.00	Professional		$254.75	$322.95	$1,627.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.47 / $52.43 / $241.00	Professional	26	$43.47	$52.43	$241.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.31 / $261.02 / $761.71	Professional	TC	$213.31	$261.02	$761.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $98.08 / $98.08 / $98.08	Professional	26	$98.08	$98.08	$98.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $288.82 / $373.22 / $827.04	Professional		$288.82	$373.22	$827.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.83 / $66.28 / $140.55	Professional	26	$52.83	$66.28	$140.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $227.26 / $308.87 / $690.57	Professional	TC	$227.26	$308.87	$690.57
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $285.63 / $436.04 / $804.36	Professional		$285.63	$436.04	$804.36
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.89 / $58.60 / $120.09	Professional	26	$47.89	$58.60	$120.09
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $246.94 / $378.47 / $683.39	Professional	TC	$246.94	$378.47	$683.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $273.77 / $413.46 / $1,038.60	Professional		$273.77	$413.46	$1,038.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.80 / $61.39 / $136.33	Professional	26	$43.80	$61.39	$136.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $227.72 / $370.27 / $904.41	Professional	TC	$227.72	$370.27	$904.41
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $131.10 / $413.11 / $557.70	Professional		$131.10	$413.11	$557.70
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.04 / $52.54 / $70.93	Professional	26	$17.04	$52.54	$70.93
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.06 / $360.57 / $486.77	Professional	TC	$114.06	$360.57	$486.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $307.79 / $405.61 / $723.78	Professional		$307.79	$405.61	$723.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.17 / $62.84 / $110.24	Professional	26	$43.17	$62.84	$110.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $276.75 / $399.66 / $677.87	Professional	TC	$276.75	$399.66	$677.87
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $112.48 / $216.00 / $231.75	Facility	26	$112.48	$216.00	$231.75
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,116.12 / $2,116.12 / $2,616.38	Professional		$2,116.12	$2,116.12	$2,616.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $350.03 / $350.03 / $378.60	Professional	26	$350.03	$350.03	$378.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,817.68 / $1,817.68 / $2,237.78	Professional	TC	$1,817.68	$1,817.68	$2,237.78
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 $273.58 / $404.59 / $1,032.14	Professional		$273.58	$404.59	$1,032.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.80 / $62.64 / $134.84	Professional	26	$43.80	$62.64	$134.84
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $226.42 / $369.42 / $904.41	Professional	TC	$226.42	$369.42	$904.41
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,180.66 / $1,180.66 / $1,180.66	Professional		$1,180.66	$1,180.66	$1,180.66
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $164.01 / $164.01 / $164.01	Professional	26	$164.01	$164.01	$164.01
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,016.64 / $1,016.64 / $1,016.64	Professional	TC	$1,016.64	$1,016.64	$1,016.64
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $196.65 / $319.69 / $459.44	Professional		$196.65	$319.69	$459.44
United Facility/Professional Professional Modifier Low / Median / High Price $243.08 / $357.65 / $1,132.56	Professional		$243.08	$357.65	$1,132.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.27 / $53.55 / $140.26	Professional	26	$39.27	$53.55	$140.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $203.81 / $306.04 / $926.24	Professional	TC	$203.81	$306.04	$926.24