Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.90 / $198.15 / $915.44	Professional		$109.90	$198.15	$915.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.36 / $52.60 / $258.37	Professional	26	$36.36	$52.60	$258.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.18 / $144.30 / $625.58	Professional	TC	$87.18	$144.30	$625.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.17 / $20.17 / $20.17	Professional	26	$20.17	$20.17	$20.17
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $152.87 / $274.35 / $528.59	Professional		$152.87	$274.35	$528.59
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.20 / $94.36 / $169.52	Professional	26	$46.20	$94.36	$169.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $99.53 / $177.03 / $350.51	Professional	TC	$99.53	$177.03	$350.51
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $144.29 / $206.13 / $480.50	Professional		$144.29	$206.13	$480.50
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $40.60 / $57.84 / $134.60	Professional	26	$40.60	$57.84	$134.60
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $103.80 / $148.28 / $341.16	Professional	TC	$103.80	$148.28	$341.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.68 / $118.11 / $347.44	Professional		$61.68	$118.11	$347.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.31 / $35.07 / $115.08	Professional	26	$21.31	$35.07	$115.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.96 / $83.24 / $256.43	Professional	TC	$40.96	$83.24	$256.43
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $75.41 / $194.80 / $262.98	Professional		$75.41	$194.80	$262.98
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.72 / $60.33 / $63.07	Professional	26	$46.72	$60.33	$63.07
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.08 / $148.08 / $199.91	Professional	TC	$15.08	$148.08	$199.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.04 / $181.42 / $301.94	Professional		$151.04	$181.42	$301.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.38 / $56.06 / $70.09	Professional	26	$37.38	$56.06	$70.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $109.40 / $177.01 / $222.12	Professional	TC	$109.40	$177.01	$222.12
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $98.60 / $271.50 / $271.50	Facility	26	$98.60	$271.50	$271.50
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,070.24 / $1,070.24 / $1,246.43	Professional		$1,070.24	$1,070.24	$1,246.43
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $390.67 / $392.28 / $392.28	Professional	26	$390.67	$392.28	$392.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $793.60 / $793.60 / $918.90	Professional	TC	$793.60	$793.60	$918.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.00 / $95.91 / $159.35	Professional		$48.00	$95.91	$159.35
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.09 / $213.29 / $398.00	Professional		$64.09	$213.29	$398.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.89 / $41.15 / $115.53	Professional	26	$21.89	$41.15	$115.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $40.96 / $87.69 / $256.43	Professional	TC	$40.96	$87.69	$256.43
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $499.71 / $499.71 / $499.71	Professional		$499.71	$499.71	$499.71
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $158.21 / $158.21 / $158.21	Professional	26	$158.21	$158.21	$158.21
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $341.49 / $341.49 / $341.49	Professional	TC	$341.49	$341.49	$341.49
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $157.57 / $157.57 / $216.66	Professional		$157.57	$157.57	$216.66
United Facility/Professional Professional Modifier Low / Median / High Price $80.33 / $126.11 / $302.66	Professional		$80.33	$126.11	$302.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.99 / $39.11 / $108.16	Professional	26	$25.99	$39.11	$108.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.34 / $87.17 / $260.70	Professional	TC	$54.34	$87.17	$260.70