Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $290.99 / $474.27 / $1,666.52	Professional		$290.99	$474.27	$1,666.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.70 / $47.56 / $209.99	Professional	26	$40.70	$47.56	$209.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $280.41 / $421.65 / $1,513.02	Professional	TC	$280.41	$421.65	$1,513.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $271.10 / $271.10 / $271.10	Professional		$271.10	$271.10	$271.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.04 / $29.04 / $29.04	Professional	26	$29.04	$29.04	$29.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $459.11 / $590.33 / $1,434.93	Professional		$459.11	$590.33	$1,434.93
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.51 / $62.25 / $137.05	Professional	26	$45.51	$62.25	$137.05
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $411.33 / $526.14 / $1,292.55	Professional	TC	$411.33	$526.14	$1,292.55
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $417.91 / $597.02 / $1,407.81	Professional		$417.91	$597.02	$1,407.81
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.05 / $60.90 / $143.50	Professional	26	$43.05	$60.90	$143.50
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $375.28 / $536.12 / $1,254.09	Professional	TC	$375.28	$536.12	$1,254.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $288.11 / $537.49 / $1,230.14	Professional		$288.11	$537.49	$1,230.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.24 / $50.06 / $114.63	Professional	26	$29.24	$50.06	$114.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $258.87 / $486.15 / $1,115.51	Professional	TC	$258.87	$486.15	$1,115.51
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $363.41 / $755.31 / $1,019.67	Professional		$363.41	$755.31	$1,019.67
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.09 / $86.52 / $323.43	Professional	26	$64.09	$86.52	$323.43
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.97 / $691.22 / $933.15	Professional	TC	$39.97	$691.22	$933.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $559.64 / $677.94 / $1,132.97	Professional		$559.64	$677.94	$1,132.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.27 / $76.91 / $96.17	Professional	26	$51.27	$76.91	$96.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $510.54 / $825.58 / $1,036.83	Professional	TC	$510.54	$825.58	$1,036.83
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $137.47 / $255.86 / $280.44	Facility	26	$137.47	$255.86	$280.44
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,946.60 / $3,946.60 / $4,720.28	Professional		$3,946.60	$3,946.60	$4,720.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $363.38 / $363.38 / $451.05	Professional	26	$363.38	$363.38	$451.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,586.83 / $3,586.83 / $4,269.22	Professional	TC	$3,586.83	$3,586.83	$4,269.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $66.98 / $493.38 / $659.05	Professional		$66.98	$493.38	$659.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $343.41 / $684.87 / $1,730.90	Professional		$343.41	$684.87	$1,730.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.61 / $54.36 / $161.11	Professional	26	$29.61	$54.36	$161.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $273.58 / $500.66 / $1,299.77	Professional	TC	$273.58	$500.66	$1,299.77
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $2,220.58 / $2,220.58 / $2,220.58	Professional		$2,220.58	$2,220.58	$2,220.58
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $219.94 / $219.94 / $219.94	Professional	26	$219.94	$219.94	$219.94
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $2,000.63 / $2,000.63 / $2,000.63	Professional	TC	$2,000.63	$2,000.63	$2,000.63
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $611.02 / $611.02 / $840.15	Professional		$611.02	$611.02	$840.15
United Facility/Professional Professional Modifier Low / Median / High Price $297.12 / $383.89 / $1,686.03	Professional		$297.12	$383.89	$1,686.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.07 / $36.21 / $190.80	Professional	26	$34.07	$36.21	$190.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.05 / $347.80 / $1,328.19	Professional	TC	$263.05	$347.80	$1,328.19