Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.42 / $63.31 / $389.34	Facility	26	$60.42	$63.31	$389.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $289.25 / $367.89 / $1,882.00	Professional		$289.25	$367.89	$1,882.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.15 / $65.73 / $336.00	Professional	26	$57.15	$65.73	$336.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $227.64 / $284.95 / $732.80	Professional	TC	$227.64	$284.95	$732.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $82.85 / $82.85 / $82.85	Professional	26	$82.85	$82.85	$82.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $288.94 / $383.99 / $866.69	Professional		$288.94	$383.99	$866.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.01 / $84.61 / $180.78	Professional	26	$67.01	$84.61	$180.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $219.62 / $303.74 / $675.59	Professional	TC	$219.62	$303.74	$675.59
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $280.14 / $431.88 / $912.44	Professional		$280.14	$431.88	$912.44
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $62.95 / $78.34 / $158.43	Professional	26	$62.95	$78.34	$158.43
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $228.41 / $355.63 / $753.68	Professional	TC	$228.41	$355.63	$753.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $294.25 / $429.88 / $1,007.38	Professional		$294.25	$429.88	$1,007.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.38 / $81.73 / $186.30	Professional	26	$56.38	$81.73	$186.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $247.34 / $358.63 / $842.87	Professional	TC	$247.34	$358.63	$842.87
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $201.93 / $404.06 / $545.48	Professional		$201.93	$404.06	$545.48
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.35 / $70.70 / $95.46	Professional	26	$36.35	$70.70	$95.46
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.58 / $333.35 / $450.02	Professional	TC	$165.58	$333.35	$450.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $302.64 / $400.64 / $773.44	Professional		$302.64	$400.64	$773.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.05 / $84.51 / $148.24	Professional	26	$58.05	$84.51	$148.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $255.83 / $383.35 / $626.70	Professional	TC	$255.83	$383.35	$626.70
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $151.49 / $286.08 / $311.41	Facility	26	$151.49	$286.08	$311.41
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,079.76 / $2,079.76 / $2,572.42	Professional		$2,079.76	$2,079.76	$2,572.42
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $405.29 / $405.29 / $505.58	Professional	26	$405.29	$405.29	$505.58
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,674.47 / $1,674.47 / $2,066.85	Professional	TC	$1,674.47	$1,674.47	$2,066.85
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 $293.95 / $418.12 / $1,007.26	Professional		$293.95	$418.12	$1,007.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.24 / $81.73 / $181.26	Professional	26	$58.24	$81.73	$181.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $247.34 / $360.01 / $842.87	Professional	TC	$247.34	$360.01	$842.87
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,145.19 / $1,145.19 / $1,145.19	Professional		$1,145.19	$1,145.19	$1,145.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $218.70 / $218.70 / $218.70	Professional	26	$218.70	$218.70	$218.70
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $926.48 / $926.48 / $926.48	Professional	TC	$926.48	$926.48	$926.48
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $262.50 / $338.57 / $449.38	Professional		$262.50	$338.57	$449.38
United Facility/Professional Professional Modifier Low / Median / High Price $295.41 / $412.88 / $1,057.72	Professional		$295.41	$412.88	$1,057.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.29 / $79.20 / $195.11	Professional	26	$58.29	$79.20	$195.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $237.12 / $320.39 / $861.34	Professional	TC	$237.12	$320.39	$861.34