Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $186.21 / $436.52	Facility	26	$141.25	$186.21	$436.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $575.44 / $2,137.96	Professional		$363.08	$575.44	$2,137.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $147.91 / $407.38	Professional	26	$74.13	$147.91	$407.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $371.54 / $1,122.02	Professional	TC	$269.15	$371.54	$1,122.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $478.63 / $741.31	Professional		$208.93	$478.63	$741.31
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $154.88 / $380.19	Professional	26	$66.07	$154.88	$380.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $1,096.48 / $1,737.80	Professional		$562.34	$1,096.48	$1,737.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $125.89 / $223.87	Professional	26	$85.11	$125.89	$223.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $954.99 / $1,548.82	Professional	TC	$467.74	$954.99	$1,548.82
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $933.25 / $1,698.24	Professional		$645.65	$933.25	$1,698.24
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $144.54 / $251.19	Professional	26	$102.33	$144.54	$251.19
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $776.25 / $1,445.44	Professional	TC	$537.03	$776.25	$1,445.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $758.58 / $1,479.11	Professional		$331.13	$758.58	$1,479.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $100.00 / $194.98	Professional	26	$52.48	$100.00	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $645.65 / $1,318.26	Professional	TC	$275.42	$645.65	$1,318.26
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $446.68 / $602.56	Professional		$323.59	$446.68	$602.56
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $77.62 / $104.71	Professional	26	$45.71	$77.62	$104.71
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $363.08 / $489.78	Professional	TC	$281.84	$363.08	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $416.87 / $812.83	Professional		$323.59	$416.87	$812.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $89.13 / $151.36	Professional	26	$67.61	$89.13	$151.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $380.19 / $691.83	Professional	TC	$302.00	$380.19	$691.83
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	26	$645.65	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,495.41 / $5,495.41 / $5,495.41	Professional		$5,495.41	$5,495.41	$5,495.41
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $812.83 / $812.83 / $812.83	Professional	26	$812.83	$812.83	$812.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,011.87 / $5,011.87 / $5,011.87	Professional	TC	$5,011.87	$5,011.87	$5,011.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $89.13 / $501.19	Professional		$32.36	$89.13	$501.19
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $741.31 / $1,412.54	Professional		$331.13	$741.31	$1,412.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $95.50 / $169.82	Professional	26	$50.12	$95.50	$169.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $645.65 / $1,318.26	Professional	TC	$269.15	$645.65	$1,318.26
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Professional		$1,230.27	$1,230.27	$1,230.27
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $239.88 / $239.88	Professional	26	$239.88	$239.88	$239.88
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Professional	TC	$1,000.00	$1,000.00	$1,000.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $416.87 / $549.54	Professional		$323.59	$416.87	$549.54
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $562.34 / $1,230.27	Professional		$323.59	$562.34	$1,230.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $75.86 / $162.18	Professional	26	$64.57	$75.86	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $467.74 / $1,071.52	Professional	TC	$257.04	$467.74	$1,071.52