Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $171.19 / $191.74 / $1,124.43	Facility	26	$171.19	$191.74	$1,124.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $278.91 / $321.86 / $1,259.00	Professional		$278.91	$321.86	$1,259.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $167.96 / $190.21 / $507.53	Professional	26	$167.96	$190.21	$507.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.51 / $116.85 / $208.40	Professional	TC	$94.51	$116.85	$208.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $241.87 / $292.61 / $485.41	Professional		$241.87	$292.61	$485.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $160.26 / $224.02 / $419.82	Professional	26	$160.26	$224.02	$419.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $258.89 / $409.58 / $850.94	Professional		$258.89	$409.58	$850.94
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $163.85 / $239.91 / $498.14	Professional	26	$163.85	$239.91	$498.14
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.20 / $167.36 / $346.54	Professional	TC	$97.20	$167.36	$346.54
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $184.14 / $272.79 / $482.73	Professional		$184.14	$272.79	$482.73
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $137.74 / $201.69 / $479.80	Professional	26	$137.74	$201.69	$479.80
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $98.86 / $137.11 / $586.00	Professional	TC	$98.86	$137.11	$586.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.49 / $396.35 / $870.60	Professional		$251.49	$396.35	$870.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $194.64 / $250.67 / $554.65	Professional	26	$194.64	$250.67	$554.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $118.85 / $164.16 / $349.97	Professional	TC	$118.85	$164.16	$349.97
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $263.45 / $346.68 / $468.02	Professional		$263.45	$346.68	$468.02
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.81 / $208.69 / $281.73	Professional	26	$15.81	$208.69	$281.73
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $137.99 / $186.29 / $284.79	Professional	TC	$137.99	$186.29	$284.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $270.45 / $338.81 / $610.58	Professional		$270.45	$338.81	$610.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $172.37 / $210.87 / $376.69	Professional	26	$172.37	$210.87	$376.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $106.43 / $137.99 / $249.07	Professional	TC	$106.43	$137.99	$249.07
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $425.11 / $829.58 / $910.58	Facility	26	$425.11	$829.58	$910.58
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,850.58 / $1,850.58 / $2,337.38	Professional		$1,850.58	$1,850.58	$2,337.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,166.03 / $1,166.03 / $1,480.73	Professional	26	$1,166.03	$1,166.03	$1,480.73
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $684.55 / $684.55 / $856.65	Professional	TC	$684.55	$684.55	$856.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $399.02	Professional		$32.34	$32.34	$399.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $314.31 / $448.56 / $782.92	Professional		$314.31	$448.56	$782.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $196.44 / $251.83 / $507.89	Professional	26	$196.44	$251.83	$507.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $123.28 / $165.90 / $339.24	Professional	TC	$123.28	$165.90	$339.24
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,007.65 / $1,007.65 / $1,007.65	Professional		$1,007.65	$1,007.65	$1,007.65
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $622.87 / $622.87 / $622.87	Professional	26	$622.87	$622.87	$622.87
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $384.78 / $384.78 / $384.78	Professional	TC	$384.78	$384.78	$384.78
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $280.31 / $342.48 / $447.86	Professional		$280.31	$342.48	$447.86
United Facility/Professional Professional Modifier Low / Median / High Price $240.80 / $341.41 / $791.96	Professional		$240.80	$341.41	$791.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $150.91 / $204.82 / $482.84	Professional	26	$150.91	$204.82	$482.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.88 / $131.38 / $333.63	Professional	TC	$89.88	$131.38	$333.63