Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.69 / $47.14 / $304.08	Facility	26	$44.69	$47.14	$304.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $280.00 / $315.18 / $1,337.76	Professional		$280.00	$315.18	$1,337.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.47 / $59.39 / $241.74	Professional	26	$43.47	$59.39	$241.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $238.57 / $271.17 / $740.36	Professional	TC	$238.57	$271.17	$740.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.53 / $81.31 / $102.16	Professional	26	$46.53	$81.31	$102.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.94 / $460.82 / $956.90	Professional		$331.94	$460.82	$956.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.21 / $64.55 / $132.08	Professional	26	$47.21	$64.55	$132.08
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $279.86 / $397.22 / $824.82	Professional	TC	$279.86	$397.22	$824.82
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $241.28 / $379.16 / $917.17	Professional		$241.28	$379.16	$917.17
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.95 / $54.25 / $131.93	Professional	26	$45.95	$54.25	$131.93
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $205.54 / $322.99 / $785.24	Professional	TC	$205.54	$322.99	$785.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $291.88 / $429.05 / $1,000.83	Professional		$291.88	$429.05	$1,000.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.71 / $64.68 / $144.22	Professional	26	$44.71	$64.68	$144.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $257.70 / $375.79 / $873.00	Professional	TC	$257.70	$375.79	$873.00
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $290.93 / $394.07 / $531.99	Professional		$290.93	$394.07	$531.99
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.72 / $54.76 / $73.93	Professional	26	$40.72	$54.76	$73.93
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $250.20 / $339.32 / $458.08	Professional	TC	$250.20	$339.32	$458.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $293.99 / $387.74 / $704.90	Professional		$293.99	$387.74	$704.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.00 / $65.54 / $114.93	Professional	26	$45.00	$65.54	$114.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $260.39 / $376.07 / $637.91	Professional	TC	$260.39	$376.07	$637.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $222.53 / $241.59	Facility	26	$117.49	$222.53	$241.59
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,033.50 / $2,033.50 / $2,498.03	Professional		$2,033.50	$2,033.50	$2,498.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $313.45 / $313.45 / $394.35	Professional	26	$313.45	$313.45	$394.35
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,720.04 / $1,720.04 / $2,103.67	Professional	TC	$1,720.04	$1,720.04	$2,103.67
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 $291.88 / $425.51 / $999.35	Professional		$291.88	$425.51	$999.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.96 / $64.70 / $143.06	Professional	26	$45.96	$64.70	$143.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $272.76 / $383.95 / $873.00	Professional	TC	$272.76	$383.95	$873.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,135.92 / $1,135.92 / $1,135.92	Professional		$1,135.92	$1,135.92	$1,135.92
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $170.97 / $170.97 / $170.97	Professional	26	$170.97	$170.97	$170.97
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $964.95 / $964.95 / $964.95	Professional	TC	$964.95	$964.95	$964.95
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $318.74 / $407.30 / $494.58	Professional		$318.74	$407.30	$494.58
United Facility/Professional Professional Modifier Low / Median / High Price $268.85 / $376.41 / $1,050.65	Professional		$268.85	$376.41	$1,050.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.78 / $58.49 / $144.19	Professional	26	$41.78	$58.49	$144.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $227.07 / $319.58 / $936.44	Professional	TC	$227.07	$319.58	$936.44