Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $44.71 / $272.80	Facility	26	$40.13	$44.71	$272.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $292.43 / $344.07 / $638.79	Professional		$292.43	$344.07	$638.79
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $141.10 / $174.02 / $254.41	Professional	52	$141.10	$174.02	$254.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.25 / $301.02 / $569.08	Professional	TC	$251.25	$301.02	$569.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $361.99 / $361.99 / $361.99	Professional		$361.99	$361.99	$361.99
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $300.22 / $411.61 / $791.40	Professional		$300.22	$411.61	$791.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $251.79 / $350.87 / $686.91	Professional	TC	$251.79	$350.87	$686.91
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $221.07 / $332.12 / $789.12	Professional		$221.07	$332.12	$789.12
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $193.37 / $291.55 / $688.65	Professional	TC	$193.37	$291.55	$688.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $317.86 / $460.22 / $1,092.66	Professional		$317.86	$460.22	$1,092.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $290.54 / $413.11 / $961.95	Professional	TC	$290.54	$413.11	$961.95
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $267.66 / $339.48 / $676.31	Professional		$267.66	$339.48	$676.31
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.47 / $47.53 / $68.28	Professional	26	$37.47	$47.53	$68.28
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $230.19 / $291.95 / $608.03	Professional	TC	$230.19	$291.95	$608.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $371.47 / $468.46 / $888.78	Professional		$371.47	$468.46	$888.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.79 / $51.10 / $91.30	Professional	26	$41.79	$51.10	$91.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $347.20 / $450.39 / $788.18	Professional	TC	$347.20	$450.39	$788.18
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $102.98 / $201.33 / $220.83	Facility	26	$102.98	$201.33	$220.83
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,332.00 / $2,332.00 / $3,148.13	Professional		$2,332.00	$2,332.00	$3,148.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,048.28 / $2,048.28 / $2,788.20	Professional	TC	$2,048.28	$2,048.28	$2,788.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $506.78	Professional		$32.34	$32.34	$506.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $344.70 / $544.17 / $968.58	Professional		$344.70	$544.17	$968.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $290.54 / $417.37 / $893.76	Professional	TC	$290.54	$417.37	$893.76
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,177.84 / $1,177.84 / $1,177.84	Professional		$1,177.84	$1,177.84	$1,177.84
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,026.26 / $1,026.26 / $1,026.26	Professional	TC	$1,026.26	$1,026.26	$1,026.26
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $278.37 / $415.74 / $557.17	Professional		$278.37	$415.74	$557.17
United Facility/Professional Professional Modifier Low / Median / High Price $269.39 / $374.48 / $910.09	Professional		$269.39	$374.48	$910.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $231.12 / $316.72 / $797.75	Professional	TC	$231.12	$316.72	$797.75