Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $154.56 / $269.60 / $710.82	Professional		$154.56	$269.60	$710.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.02 / $70.88 / $523.14	Professional	26	$45.02	$70.88	$523.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.55 / $160.97 / $1,882.30	Professional	TC	$109.55	$160.97	$1,882.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.65 / $109.44 / $310.58	Professional	26	$30.65	$109.44	$310.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $286.00 / $371.80 / $817.65	Professional		$286.00	$371.80	$817.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.70 / $102.90 / $204.28	Professional	26	$69.70	$102.90	$204.28
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $206.23 / $268.08 / $632.54	Professional	TC	$206.23	$268.08	$632.54
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $170.26 / $243.23 / $607.09	Professional		$170.26	$243.23	$607.09
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $52.74 / $71.17 / $171.96	Professional	26	$52.74	$71.17	$171.96
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $120.88 / $172.69 / $431.04	Professional	TC	$120.88	$172.69	$431.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.23 / $238.54 / $791.43	Professional		$114.23	$238.54	$791.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.58 / $37.74 / $126.16	Professional	26	$32.58	$37.74	$126.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.27 / $188.29 / $615.01	Professional	TC	$80.27	$188.29	$615.01
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $192.08 / $517.55 / $698.71	Professional		$192.08	$517.55	$698.71
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.70 / $70.53 / $95.22	Professional	26	$55.70	$70.53	$95.22
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $136.38 / $447.04 / $603.50	Professional	TC	$136.38	$447.04	$603.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $393.93 / $468.44 / $772.87	Professional		$393.93	$468.44	$772.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.42 / $84.64 / $105.81	Professional	26	$56.42	$84.64	$105.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $330.20 / $534.04 / $670.56	Professional	TC	$330.20	$534.04	$670.56
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $151.56 / $283.08 / $309.61	Facility	26	$151.56	$283.08	$309.61
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,575.76 / $2,575.76 / $3,260.25	Professional		$2,575.76	$2,575.76	$3,260.25
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $393.91 / $393.91 / $495.83	Professional	26	$393.91	$393.91	$495.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,181.85 / $2,181.85 / $2,764.35	Professional	TC	$2,181.85	$2,181.85	$2,764.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $73.54 / $365.54 / $439.08	Professional		$73.54	$365.54	$439.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $121.17 / $305.52 / $1,073.14	Professional		$121.17	$305.52	$1,073.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.04 / $41.12 / $136.19	Professional	26	$33.04	$41.12	$136.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $82.82 / $193.35 / $647.42	Professional	TC	$82.82	$193.35	$647.42
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,547.58 / $1,547.58 / $1,547.58	Professional		$1,547.58	$1,547.58	$1,547.58
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $246.11 / $246.11 / $246.11	Professional	26	$246.11	$246.11	$246.11
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,301.47 / $1,301.47 / $1,301.47	Professional	TC	$1,301.47	$1,301.47	$1,301.47
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $418.68 / $418.68 / $575.69	Professional		$418.68	$418.68	$575.69
United Facility/Professional Professional Modifier Low / Median / High Price $132.30 / $247.27 / $1,244.78	Professional		$132.30	$247.27	$1,244.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.61 / $41.72 / $148.47	Professional	26	$37.61	$41.72	$148.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $94.37 / $206.57 / $757.44	Professional	TC	$94.37	$206.57	$757.44