Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.95 / $184.22 / $613.83	Professional		$115.95	$184.22	$613.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.80 / $45.21 / $173.42	Professional	26	$18.80	$45.21	$173.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.66 / $139.26 / $721.61	Professional	TC	$83.66	$139.26	$721.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.42 / $51.42 / $51.42	Professional	26	$51.42	$51.42	$51.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.13 / $245.65 / $504.52	Professional		$190.13	$245.65	$504.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.93 / $64.15 / $109.48	Professional	26	$27.93	$64.15	$109.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $136.97 / $178.06 / $379.35	Professional	TC	$136.97	$178.06	$379.35
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $166.54 / $238.54 / $578.80	Professional		$166.54	$238.54	$578.80
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $40.38 / $57.42 / $136.34	Professional	26	$40.38	$57.42	$136.34
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $126.78 / $181.12 / $435.80	Professional	TC	$126.78	$181.12	$435.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.62 / $123.12 / $372.73	Professional		$66.62	$123.12	$372.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.76 / $27.06 / $77.02	Professional	26	$12.76	$27.06	$77.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.09 / $95.55 / $320.11	Professional	TC	$53.09	$95.55	$320.11
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $112.83 / $260.35 / $351.47	Professional		$112.83	$260.35	$351.47
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.22 / $34.04 / $90.26	Professional	26	$25.22	$34.04	$90.26
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $235.12 / $317.41	Professional	TC	$22.57	$235.12	$317.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.57 / $241.24 / $390.53	Professional		$199.57	$241.24	$390.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.18 / $30.26 / $37.85	Professional	26	$20.18	$30.26	$37.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.71 / $281.14 / $352.68	Professional	TC	$173.71	$281.14	$352.68
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $55.44 / $240.51 / $240.51	Facility	26	$55.44	$240.51	$240.51
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,336.58 / $1,336.58 / $1,642.13	Professional		$1,336.58	$1,336.58	$1,642.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $262.83 / $315.72 / $315.72	Professional	26	$262.83	$315.72	$315.72
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,188.97 / $1,188.97 / $1,461.53	Professional	TC	$1,188.97	$1,188.97	$1,461.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.94 / $163.28 / $223.47	Professional		$22.94	$163.28	$223.47
Providence Facility/Professional Professional Modifier Low / Median / High Price $74.95 / $241.42 / $557.30	Professional		$74.95	$241.42	$557.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.31 / $28.60 / $77.02	Professional	26	$13.31	$28.60	$77.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.99 / $119.03 / $310.45	Professional	TC	$56.99	$119.03	$310.45
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $686.78 / $686.78 / $686.78	Professional		$686.78	$686.78	$686.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $94.66 / $94.66 / $94.66	Professional	26	$94.66	$94.66	$94.66
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $592.12 / $592.12 / $592.12	Professional	TC	$592.12	$592.12	$592.12
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $210.58 / $210.58 / $289.55	Professional		$210.58	$210.58	$289.55
United Facility/Professional Professional Modifier Low / Median / High Price $96.80 / $127.12 / $520.55	Professional		$96.80	$127.12	$520.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.59 / $25.98 / $74.81	Professional	26	$15.59	$25.98	$74.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.37 / $101.89 / $454.98	Professional	TC	$66.37	$101.89	$454.98