Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.65 / $211.63 / $493.71	Professional		$128.65	$211.63	$493.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.07 / $43.86 / $131.35	Professional	26	$31.07	$43.86	$131.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.73 / $174.01 / $696.04	Professional	TC	$117.73	$174.01	$696.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.54 / $67.25 / $90.77	Professional	26	$19.54	$67.25	$90.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $276.76 / $359.80 / $727.00	Professional		$276.76	$359.80	$727.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.80 / $71.09 / $141.13	Professional	26	$47.80	$71.09	$141.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $221.65 / $288.14 / $633.01	Professional	TC	$221.65	$288.14	$633.01
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $164.03 / $234.33 / $571.23	Professional		$164.03	$234.33	$571.23
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $6.48 / $8.60 / $14.44	Professional	26	$6.48	$8.60	$14.44
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $148.07 / $211.53 / $302.08	Professional	TC	$148.07	$211.53	$302.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.66 / $216.43 / $664.55	Professional		$109.66	$216.43	$664.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.21 / $26.18 / $87.86	Professional	26	$22.21	$26.18	$87.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.27 / $177.54 / $576.69	Professional	TC	$86.27	$177.54	$576.69
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $185.00 / $364.10 / $491.54	Professional		$185.00	$364.10	$491.54
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.85 / $45.27 / $61.11	Professional	26	$38.85	$45.27	$61.11
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $146.15 / $318.83 / $430.42	Professional	TC	$146.15	$318.83	$430.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $279.43 / $337.80 / $543.34	Professional		$279.43	$337.80	$543.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.22 / $54.32 / $67.91	Professional	26	$36.22	$54.32	$67.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $235.50 / $380.87 / $478.25	Professional	TC	$235.50	$380.87	$478.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $98.57 / $183.18 / $199.50	Facility	26	$98.57	$183.18	$199.50
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,077.04 / $2,077.04 / $2,291.85	Professional		$2,077.04	$2,077.04	$2,291.85
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $267.88 / $267.88 / $320.70	Professional	26	$267.88	$267.88	$320.70
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,809.15 / $1,809.15 / $1,971.15	Professional	TC	$1,809.15	$1,809.15	$1,971.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $49.30 / $286.20 / $335.50	Professional		$49.30	$286.20	$335.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $116.74 / $292.87 / $864.83	Professional		$116.74	$292.87	$864.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.58 / $28.88 / $93.99	Professional	26	$22.58	$28.88	$93.99
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $89.01 / $186.80 / $604.37	Professional	TC	$89.01	$186.80	$604.37
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,311.19 / $1,311.19 / $1,311.19	Professional		$1,311.19	$1,311.19	$1,311.19
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $168.85 / $168.85 / $168.85	Professional	26	$168.85	$168.85	$168.85
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,142.33 / $1,142.33 / $1,142.33	Professional	TC	$1,142.33	$1,142.33	$1,142.33
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $294.54 / $294.54 / $404.99	Professional		$294.54	$294.54	$404.99
United Facility/Professional Professional Modifier Low / Median / High Price $126.55 / $208.96 / $804.45	Professional		$126.55	$208.96	$804.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.73 / $28.65 / $156.32	Professional	26	$25.73	$28.65	$156.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.67 / $181.24 / $664.55	Professional	TC	$98.67	$181.24	$664.55