Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $300.18 / $373.22 / $764.81	Professional		$300.18	$373.22	$764.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $113.49 / $149.78 / $568.10	Professional	26	$113.49	$149.78	$568.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.94 / $226.44 / $544.17	Professional	TC	$181.94	$226.44	$544.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.50 / $246.85 / $617.98	Professional	26	$67.50	$246.85	$617.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $171.65 / $380.05 / $1,037.43	Professional		$171.65	$380.05	$1,037.43
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $124.04 / $165.68 / $385.83	Professional	26	$124.04	$165.68	$385.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.76 / $213.29 / $651.57	Professional	TC	$75.76	$213.29	$651.57
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $219.14 / $313.06 / $728.38	Professional		$219.14	$313.06	$728.38
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $89.09 / $126.47 / $292.49	Professional	26	$89.09	$126.47	$292.49
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $130.54 / $186.48 / $436.65	Professional	TC	$130.54	$186.48	$436.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.05 / $257.42 / $844.71	Professional		$162.05	$257.42	$844.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.94 / $84.54 / $295.00	Professional	26	$70.94	$84.54	$295.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.24 / $169.26 / $568.60	Professional	TC	$89.24	$169.26	$568.60
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $185.47 / $556.85 / $751.75	Professional		$185.47	$556.85	$751.75
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $148.38 / $160.62 / $216.84	Professional	26	$148.38	$160.62	$216.84
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.09 / $396.23 / $534.91	Professional	TC	$37.09	$396.23	$534.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $415.38 / $513.22 / $835.38	Professional		$415.38	$513.22	$835.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $128.50 / $192.74 / $240.98	Professional	26	$128.50	$192.74	$240.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $292.70 / $473.49 / $594.35	Professional	TC	$292.70	$473.49	$594.35
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $330.26 / $632.78 / $698.35	Facility	26	$330.26	$632.78	$698.35
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,755.28 / $2,755.28 / $3,572.93	Professional		$2,755.28	$2,755.28	$3,572.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $895.79 / $895.79 / $1,118.55	Professional	26	$895.79	$895.79	$1,118.55
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,859.49 / $1,859.49 / $2,454.38	Professional	TC	$1,859.49	$1,859.49	$2,454.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $165.64 / $270.26 / $489.95	Professional		$165.64	$270.26	$489.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $185.54 / $431.39 / $1,155.14	Professional		$185.54	$431.39	$1,155.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.23 / $90.22 / $361.48	Professional	26	$71.23	$90.22	$361.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $89.24 / $174.83 / $688.00	Professional	TC	$89.24	$174.83	$688.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,597.17 / $1,597.17 / $1,597.17	Professional		$1,597.17	$1,597.17	$1,597.17
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $558.51 / $558.51 / $558.51	Professional	26	$558.51	$558.51	$558.51
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,038.65 / $1,038.65 / $1,038.65	Professional	TC	$1,038.65	$1,038.65	$1,038.65
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $450.42 / $450.42 / $619.33	Professional		$450.42	$450.42	$619.33
United Facility/Professional Professional Modifier Low / Median / High Price $193.81 / $265.93 / $940.85	Professional		$193.81	$265.93	$940.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.13 / $92.80 / $329.17	Professional	26	$81.13	$92.80	$329.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.51 / $176.67 / $605.00	Professional	TC	$109.51	$176.67	$605.00