Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.55 / $50.84 / $303.02	Facility	26	$48.55	$50.84	$303.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $303.73 / $357.92 / $1,800.00	Professional		$303.73	$357.92	$1,800.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.85 / $50.84 / $218.09	Professional	26	$45.85	$50.84	$218.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $260.04 / $308.92 / $867.91	Professional	TC	$260.04	$308.92	$867.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $278.70 / $278.70 / $278.70	Professional		$278.70	$278.70	$278.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.80 / $62.80 / $66.36	Professional	26	$62.80	$62.80	$66.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $341.54 / $437.86 / $916.58	Professional		$341.54	$437.86	$916.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.44 / $71.09 / $145.19	Professional	26	$55.44	$71.09	$145.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $285.01 / $368.50 / $771.38	Professional	TC	$285.01	$368.50	$771.38
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $279.83 / $432.31 / $950.76	Professional		$279.83	$432.31	$950.76
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.50 / $60.44 / $126.45	Professional	26	$50.50	$60.44	$126.45
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $239.81 / $373.44 / $828.29	Professional	TC	$239.81	$373.44	$828.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $313.05 / $472.60 / $1,099.54	Professional		$313.05	$472.60	$1,099.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.23 / $65.18 / $144.16	Professional	26	$45.23	$65.18	$144.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $260.04 / $408.84 / $955.38	Professional	TC	$260.04	$408.84	$955.38
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $451.23 / $451.23 / $609.16	Professional		$451.23	$451.23	$609.16
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $55.00 / $74.25	Professional	26	$55.00	$55.00	$74.25
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $396.23 / $396.23 / $534.91	Professional	TC	$396.23	$396.23	$534.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $335.99 / $442.91 / $804.93	Professional		$335.99	$442.91	$804.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.24 / $65.95 / $115.62	Professional	26	$45.24	$65.95	$115.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $304.05 / $439.13 / $743.02	Professional	TC	$304.05	$439.13	$743.02
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $118.60 / $236.00 / $242.96	Facility	26	$118.60	$236.00	$242.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,348.14 / $2,348.14 / $2,851.13	Professional		$2,348.14	$2,348.14	$2,851.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $379.76 / $379.76 / $396.68	Professional	26	$379.76	$379.76	$396.68
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,034.68 / $2,034.68 / $2,454.38	Professional	TC	$2,034.68	$2,034.68	$2,454.38
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 $324.23 / $469.04 / $1,034.20	Professional		$324.23	$469.04	$1,034.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.23 / $65.27 / $140.79	Professional	26	$45.23	$65.27	$140.79
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $267.10 / $408.84 / $1,012.62	Professional	TC	$267.10	$408.84	$1,012.62
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,325.76 / $1,325.76 / $1,325.76	Professional		$1,325.76	$1,325.76	$1,325.76
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $170.87 / $170.87 / $170.87	Professional	26	$170.87	$170.87	$170.87
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,154.89 / $1,154.89 / $1,154.89	Professional	TC	$1,154.89	$1,154.89	$1,154.89
United Facility/Professional Professional Modifier Low / Median / High Price $258.62 / $401.32 / $1,202.50	Professional		$258.62	$401.32	$1,202.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.76 / $56.66 / $153.38	Professional	26	$41.76	$56.66	$153.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $219.12 / $347.55 / $1,008.69	Professional	TC	$219.12	$347.55	$1,008.69