Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $190.55 / $1,047.13	Facility	26	$169.82	$190.55	$1,047.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $354.81 / $1,288.25	Professional		$281.84	$354.81	$1,288.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $204.17 / $724.44	Professional	26	$169.82	$204.17	$724.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $123.03 / $251.19	Professional	TC	$95.50	$123.03	$251.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $281.84 / $676.08	Professional		$251.19	$281.84	$676.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $398.11 / $446.68	Professional	26	$239.88	$398.11	$446.68
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $467.74 / $891.25	Professional		$295.12	$467.74	$891.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $275.42 / $537.03	Professional	26	$190.55	$275.42	$537.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $194.98 / $354.81	Professional	TC	$109.65	$194.98	$354.81
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $316.23 / $575.44	Professional		$257.04	$316.23	$575.44
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $234.42 / $478.63	Professional	26	$186.21	$234.42	$478.63
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $173.78 / $537.03	Professional	TC	$117.49	$173.78	$537.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $407.38 / $812.83	Professional		$316.23	$407.38	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $251.19 / $501.19	Professional	26	$194.98	$251.19	$501.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $154.88 / $309.03	Professional	TC	$117.49	$154.88	$309.03
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $380.19 / $501.19	Professional		$263.03	$380.19	$501.19
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $223.87 / $288.40	Professional	26	$15.85	$223.87	$288.40
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $218.78 / $245.47	Professional	TC	$158.49	$218.78	$245.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $346.74 / $588.84	Professional		$295.12	$346.74	$588.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $204.17 / $346.74	Professional	26	$181.97	$204.17	$346.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $144.54 / $239.88	Professional	TC	$123.03	$144.54	$239.88
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Facility	26	$1,174.90	$1,174.90	$1,174.90
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,344.23 / $2,344.23	Professional		$1,862.09	$2,344.23	$2,344.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,174.90 / $1,479.11 / $1,479.11	Professional	26	$1,174.90	$1,479.11	$1,479.11
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $851.14 / $851.14	Professional	TC	$691.83	$851.14	$851.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $263.03 / $398.11	Professional		$138.04	$263.03	$398.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $416.87 / $776.25	Professional		$316.23	$416.87	$776.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $251.19 / $467.74	Professional	26	$194.98	$251.19	$467.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $158.49 / $295.12	Professional	TC	$117.49	$158.49	$295.12
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Professional		$1,000.00	$1,000.00	$1,000.00
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $616.60 / $616.60 / $616.60	Professional	26	$616.60	$616.60	$616.60
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $389.05 / $389.05	Professional	TC	$389.05	$389.05	$389.05
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $346.74 / $446.68	Professional		$263.03	$346.74	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $338.84 / $724.44	Professional		$245.47	$338.84	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $208.93 / $446.68	Professional	26	$154.88	$208.93	$446.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $128.82 / $288.40	Professional	TC	$89.13	$128.82	$288.40