Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.56 / $127.80 / $388.35	Professional		$103.56	$127.80	$388.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.94 / $39.39 / $307.04	Professional	26	$29.94	$39.39	$307.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.02 / $79.77 / $296.42	Professional	TC	$63.02	$79.77	$296.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.13 / $94.95 / $358.27	Professional		$84.13	$94.95	$358.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.09 / $72.72 / $84.51	Professional	26	$18.09	$72.72	$84.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $156.12 / $202.35 / $405.49	Professional		$156.12	$202.35	$405.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.50 / $63.54 / $123.27	Professional	26	$41.50	$63.54	$123.27
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $106.71 / $138.72 / $297.92	Professional	TC	$106.71	$138.72	$297.92
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $99.07 / $132.66 / $323.41	Professional		$99.07	$132.66	$323.41
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.61 / $40.84 / $66.16	Professional	26	$30.61	$40.84	$66.16
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $63.08 / $84.17 / $118.60	Professional	TC	$63.08	$84.17	$118.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $312.51 / $312.51 / $312.51	Facility		$312.51	$312.51	$312.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.39 / $114.22 / $338.34	Professional		$62.39	$114.22	$338.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.61 / $23.40 / $77.84	Professional	26	$19.61	$23.40	$77.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.55 / $82.13 / $256.56	Professional	TC	$41.55	$82.13	$256.56
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $104.92 / $228.43 / $308.38	Professional		$104.92	$228.43	$308.38
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.61 / $42.85 / $57.85	Professional	26	$34.61	$42.85	$57.85
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.30 / $185.58 / $250.53	Professional	TC	$70.30	$185.58	$250.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $176.00 / $212.25 / $342.65	Professional		$176.00	$212.25	$342.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.28 / $51.42 / $64.29	Professional	26	$34.28	$51.42	$64.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $137.07 / $221.67 / $278.37	Professional	TC	$137.07	$221.67	$278.37
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $379.24 / $782.64 / $928.91	Facility		$379.24	$782.64	$928.91
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $88.99 / $213.67 / $213.67	Facility	26	$88.99	$213.67	$213.67
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,081.50 / $1,081.50 / $1,445.93	Professional		$1,081.50	$1,081.50	$1,445.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $235.79 / $235.79 / $299.10	Professional	26	$235.79	$235.79	$299.10
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $845.71 / $845.71 / $1,146.83	Professional	TC	$845.71	$845.71	$1,146.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $43.89 / $143.16 / $187.05	Professional		$43.89	$143.16	$187.05
Providence Facility/Professional Facility Modifier Low / Median / High Price $119.31 / $232.30 / $312.51	Facility		$119.31	$232.30	$312.51
Providence Facility/Professional Professional Modifier Low / Median / High Price $66.20 / $163.77 / $470.95	Professional		$66.20	$163.77	$470.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.79 / $25.53 / $83.97	Professional	26	$19.79	$25.53	$83.97
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.88 / $89.16 / $271.99	Professional	TC	$42.88	$89.16	$271.99
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $658.00 / $658.00 / $658.00	Professional		$658.00	$658.00	$658.00
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $146.55 / $146.55 / $146.55	Professional	26	$146.55	$146.55	$146.55
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $511.45 / $511.45 / $511.45	Professional	TC	$511.45	$511.45	$511.45
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $184.78 / $184.78 / $254.08	Professional		$184.78	$184.78	$254.08
United Facility/Professional Professional Modifier Low / Median / High Price $74.34 / $105.24 / $402.03	Professional		$74.34	$105.24	$402.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.55 / $25.47 / $98.86	Professional	26	$23.55	$25.47	$98.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.88 / $81.48 / $297.75	Professional	TC	$48.88	$81.48	$297.75