Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $394.63 / $552.54 / $1,050.74	Professional		$394.63	$552.54	$1,050.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $143.80 / $177.30 / $500.40	Professional	26	$143.80	$177.30	$500.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $209.01 / $364.75 / $752.59	Professional	TC	$209.01	$364.75	$752.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $196.94 / $421.52 / $650.35	Professional		$196.94	$421.52	$650.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $355.83 / $355.83 / $355.83	Professional	26	$355.83	$355.83	$355.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $184.23 / $744.00 / $1,520.77	Professional		$184.23	$744.00	$1,520.77
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.73 / $212.57 / $479.93	Professional	26	$74.73	$212.57	$479.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $105.03 / $528.76 / $935.92	Professional	TC	$105.03	$528.76	$935.92
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $483.48 / $690.68 / $1,538.97	Professional		$483.48	$690.68	$1,538.97
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $137.01 / $195.73 / $472.77	Professional	26	$137.01	$195.73	$472.77
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $371.20 / $564.03 / $1,256.77	Professional	TC	$371.20	$564.03	$1,256.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $446.71 / $446.71 / $446.71	Facility		$446.71	$446.71	$446.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $326.16 / $326.16 / $326.16	Professional		$326.16	$326.16	$326.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $153.56 / $153.56 / $153.56	Professional	26	$153.56	$153.56	$153.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $172.60 / $172.60 / $172.60	Professional	TC	$172.60	$172.60	$172.60
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $342.30 / $461.68 / $623.27	Professional		$342.30	$461.68	$623.27
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.42 / $196.72 / $265.57	Professional	26	$92.42	$196.72	$265.57
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $249.88 / $264.95 / $357.70	Professional	TC	$249.88	$264.95	$357.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $363.72 / $434.36 / $707.23	Professional		$363.72	$434.36	$707.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $157.38 / $236.06 / $295.14	Professional	26	$157.38	$236.06	$295.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $195.74 / $316.77 / $397.44	Professional	TC	$195.74	$316.77	$397.44
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $695.19 / $2,185.65 / $2,185.65	Facility		$695.19	$2,185.65	$2,185.65
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $304.24 / $846.88 / $858.66	Facility	26	$304.24	$846.88	$858.66
Lucent Health Facility/Professional Facility Modifier TC Low / Median / High Price $414.58 / $1,452.72 / $1,452.72	Facility	TC	$414.58	$1,452.72	$1,452.72
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,718.36 / $5,718.36 / $5,718.36	Professional		$5,718.36	$5,718.36	$5,718.36
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,098.38 / $1,098.38 / $1,377.38	Professional	26	$1,098.38	$1,098.38	$1,377.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,767.92 / $2,229.25 / $2,229.25	Professional	TC	$1,767.92	$2,229.25	$2,229.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $396.95 / $491.46 / $1,147.43	Facility		$396.95	$491.46	$1,147.43
Providence Facility/Professional Professional Modifier Low / Median / High Price $326.16 / $326.16 / $984.20	Professional		$326.16	$326.16	$984.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $153.56 / $153.56 / $153.56	Professional	26	$153.56	$153.56	$153.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $172.60 / $172.60 / $172.60	Professional	TC	$172.60	$172.60	$172.60
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,135.81 / $1,135.81 / $1,135.81	Professional		$1,135.81	$1,135.81	$1,135.81
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $596.50 / $596.50 / $596.50	Professional	26	$596.50	$596.50	$596.50
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $539.29 / $539.29 / $539.29	Professional	TC	$539.29	$539.29	$539.29
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $373.42 / $513.45 / $550.33	Professional		$373.42	$513.45	$550.33
United Facility/Professional Professional Modifier Low / Median / High Price $208.74 / $379.20 / $1,008.01	Professional		$208.74	$379.20	$1,008.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.26 / $117.12 / $725.37	Professional	26	$109.26	$117.12	$725.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.44 / $195.83 / $607.46	Professional	TC	$97.44	$195.83	$607.46