Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.71 / $251.16 / $1,243.63	Professional		$175.71	$251.16	$1,243.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.78 / $109.96 / $893.06	Professional	26	$79.78	$109.96	$893.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.43 / $127.12 / $732.18	Professional	TC	$88.43	$127.12	$732.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $115.74 / $115.74 / $115.74	Professional		$115.74	$115.74	$115.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $233.03 / $338.08 / $683.32	Professional		$233.03	$338.08	$683.32
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $129.75 / $186.84 / $366.76	Professional	26	$129.75	$186.84	$366.76
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.79 / $165.03 / $319.33	Professional	TC	$60.79	$165.03	$319.33
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $224.28 / $323.72 / $789.13	Professional		$224.28	$323.72	$789.13
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $130.63 / $189.92 / $459.50	Professional	26	$130.63	$189.92	$459.50
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $133.80 / $321.18	Professional	TC	$100.00	$133.80	$321.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.08 / $162.13 / $509.62	Professional		$111.08	$162.13	$509.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.68 / $76.31 / $253.23	Professional	26	$63.68	$76.31	$253.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.80 / $81.34 / $276.12	Professional	TC	$46.80	$81.34	$276.12
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $180.81 / $293.10 / $395.69	Professional		$180.81	$293.10	$395.69
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.72 / $144.65 / $177.84	Professional	26	$131.72	$144.65	$177.84
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.15 / $161.37 / $217.85	Professional	TC	$36.15	$161.37	$217.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $232.83 / $279.19 / $447.42	Professional		$232.83	$279.19	$447.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $105.38 / $158.08 / $197.61	Professional	26	$105.38	$158.08	$197.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $119.26 / $193.21 / $242.06	Professional	TC	$119.26	$193.21	$242.06
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $290.20 / $579.90 / $581.40	Facility	26	$290.20	$579.90	$581.40
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,548.81 / $1,548.81 / $1,941.23	Professional		$1,548.81	$1,548.81	$1,941.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $832.85 / $836.46 / $931.13	Professional	26	$832.85	$836.46	$931.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $785.37 / $806.89 / $1,010.10	Professional	TC	$785.37	$806.89	$1,010.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $104.88 / $119.21 / $266.37	Professional		$104.88	$119.21	$266.37
Providence Facility/Professional Professional Modifier Low / Median / High Price $116.02 / $294.99 / $649.29	Professional		$116.02	$294.99	$649.29
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.28 / $80.80 / $342.00	Professional	26	$64.28	$80.80	$342.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $48.22 / $81.50 / $276.12	Professional	TC	$48.22	$81.50	$276.12
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $887.18 / $887.18 / $887.18	Professional		$887.18	$887.18	$887.18
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $487.50 / $487.50 / $487.50	Professional	26	$487.50	$487.50	$487.50
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $399.68 / $399.68 / $399.68	Professional	TC	$399.68	$399.68	$399.68
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $237.06 / $237.06 / $325.95	Professional		$237.06	$237.06	$325.95
United Facility/Professional Professional Modifier Low / Median / High Price $141.11 / $171.24 / $532.98	Professional		$141.11	$171.24	$532.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.93 / $84.27 / $378.41	Professional	26	$74.93	$84.27	$378.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.88 / $87.83 / $305.35	Professional	TC	$63.88	$87.83	$305.35