Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.33 / $57.27 / $342.92	Facility	26	$51.33	$57.27	$342.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $328.32 / $410.19 / $1,409.64	Professional		$328.32	$410.19	$1,409.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.32 / $65.36 / $251.00	Professional	26	$51.32	$65.36	$251.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $268.39 / $356.02 / $726.55	Professional	TC	$268.39	$356.02	$726.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $376.62 / $453.31 / $704.93	Professional		$376.62	$453.31	$704.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.96 / $57.09 / $87.57	Professional	26	$48.96	$57.09	$87.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $362.82 / $362.82 / $362.82	Professional	TC	$362.82	$362.82	$362.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $175.67 / $345.26 / $713.49	Professional		$175.67	$345.26	$713.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.20 / $66.15 / $155.38	Professional	26	$50.20	$66.15	$155.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $103.58 / $265.18 / $605.23	Professional	TC	$103.58	$265.18	$605.23
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $187.36 / $274.18 / $690.49	Professional		$187.36	$274.18	$690.49
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.36 / $50.00 / $121.57	Professional	26	$36.36	$50.00	$121.57
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $152.80 / $225.05 / $566.53	Professional	TC	$152.80	$225.05	$566.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.01 / $522.41 / $1,286.50	Professional		$223.01	$522.41	$1,286.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.75 / $72.34 / $163.16	Professional	26	$55.75	$72.34	$163.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.15 / $462.70 / $1,128.35	Professional	TC	$165.15	$462.70	$1,128.35
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $65.01 / $82.45 / $818.94	Professional		$65.01	$82.45	$818.94
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.46 / $43.70 / $85.55	Professional	26	$34.46	$43.70	$85.55
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.55 / $38.75 / $733.39	Professional	TC	$30.55	$38.75	$733.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $449.93 / $569.67 / $928.39	Professional		$449.93	$569.67	$928.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.31 / $64.04 / $114.38	Professional	26	$52.31	$64.04	$114.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $418.80 / $543.25 / $878.93	Professional	TC	$418.80	$543.25	$878.93
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $128.97 / $251.32 / $276.20	Facility	26	$128.97	$251.32	$276.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,879.21 / $2,879.21 / $3,811.50	Professional		$2,879.21	$2,879.21	$3,811.50
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $356.25 / $356.25 / $447.83	Professional	26	$356.25	$356.25	$447.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,522.94 / $2,522.94 / $3,363.60	Professional	TC	$2,522.94	$2,522.94	$3,363.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $615.05	Professional		$32.34	$32.34	$615.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $250.76 / $642.25 / $1,195.90	Professional		$250.76	$642.25	$1,195.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.75 / $73.55 / $155.02	Professional	26	$55.75	$73.55	$155.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $165.15 / $454.23 / $1,033.34	Professional	TC	$165.15	$454.23	$1,033.34
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,459.25 / $1,459.25 / $1,459.25	Professional		$1,459.25	$1,459.25	$1,459.25
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $190.15 / $190.15 / $190.15	Professional	26	$190.15	$190.15	$190.15
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,269.08 / $1,269.08 / $1,269.08	Professional	TC	$1,269.08	$1,269.08	$1,269.08
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $82.45 / $158.52 / $674.71	Professional		$82.45	$158.52	$674.71
United Facility/Professional Professional Modifier Low / Median / High Price $243.61 / $421.68 / $1,122.72	Professional		$243.61	$421.68	$1,122.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.92 / $61.12 / $141.79	Professional	26	$45.92	$61.12	$141.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.11 / $359.90 / $980.93	Professional	TC	$190.11	$359.90	$980.93