Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.31 / $89.51 / $516.73	Facility	26	$81.31	$89.51	$516.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $346.94 / $403.00 / $809.54	Professional		$346.94	$403.00	$809.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.27 / $91.46 / $427.00	Professional	26	$79.27	$91.46	$427.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $265.87 / $326.23 / $677.81	Professional	TC	$265.87	$326.23	$677.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $266.33 / $409.11 / $812.27	Professional		$266.33	$409.11	$812.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.65 / $96.75 / $118.74	Professional	26	$72.65	$96.75	$118.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.44 / $398.66 / $761.70	Professional		$245.44	$398.66	$761.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.63 / $102.83 / $201.62	Professional	26	$78.63	$102.83	$201.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $126.91 / $285.92 / $565.12	Professional	TC	$126.91	$285.92	$565.12
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $221.17 / $324.89 / $794.29	Professional		$221.17	$324.89	$794.29
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.58 / $82.10 / $193.36	Professional	26	$59.58	$82.10	$193.36
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $165.95 / $237.21 / $595.97	Professional	TC	$165.95	$237.21	$595.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $308.77 / $548.62 / $1,318.42	Professional		$308.77	$548.62	$1,318.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.18 / $112.38 / $248.05	Professional	26	$88.18	$112.38	$248.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $215.32 / $444.31 / $1,062.09	Professional	TC	$215.32	$444.31	$1,062.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $111.34 / $141.21 / $795.69	Professional		$111.34	$141.21	$795.69
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.80 / $84.73 / $129.41	Professional	26	$66.80	$84.73	$129.41
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.54 / $56.48 / $666.28	Professional	TC	$44.54	$56.48	$666.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $439.73 / $558.05 / $906.55	Professional		$439.73	$558.05	$906.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $79.12 / $96.87 / $173.05	Professional	26	$79.12	$96.87	$173.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $380.43 / $493.54 / $801.00	Professional	TC	$380.43	$493.54	$801.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $194.95 / $379.97 / $417.76	Facility	26	$194.95	$379.97	$417.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,747.80 / $2,747.80 / $3,731.33	Professional		$2,747.80	$2,747.80	$3,731.33
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $677.18 / $774.69 / $774.69	Professional	26	$677.18	$774.69	$774.69
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,208.88 / $2,208.88 / $3,054.08	Professional	TC	$2,208.88	$2,208.88	$3,054.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $602.07	Professional		$32.34	$32.34	$602.07
Providence Facility/Professional Professional Modifier Low / Median / High Price $350.87 / $637.96 / $1,142.89	Professional		$350.87	$637.96	$1,142.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $88.93 / $113.42 / $233.01	Professional	26	$88.93	$113.42	$233.01
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $221.65 / $444.76 / $904.77	Professional	TC	$221.65	$444.76	$904.77
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,373.08 / $1,373.08 / $1,373.08	Professional		$1,373.08	$1,373.08	$1,373.08
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $286.70 / $286.70 / $286.70	Professional	26	$286.70	$286.70	$286.70
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,086.36 / $1,086.36 / $1,086.36	Professional	TC	$1,086.36	$1,086.36	$1,086.36
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $141.21 / $271.50 / $655.53	Professional		$141.21	$271.50	$655.53
United Facility/Professional Professional Modifier Low / Median / High Price $289.56 / $425.80 / $1,154.18	Professional		$289.56	$425.80	$1,154.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.20 / $94.62 / $213.75	Professional	26	$70.20	$94.62	$213.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $213.71 / $326.97 / $941.91	Professional	TC	$213.71	$326.97	$941.91