Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $269.15 / $660.69	Facility	26	$141.25	$269.15	$660.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $691.83 / $3,235.94	Professional		$457.09	$691.83	$3,235.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $186.21 / $512.86	Professional	26	$109.65	$186.21	$512.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $426.58 / $1,230.27	Professional	TC	$331.13	$426.58	$1,230.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $416.87 / $851.14	Professional		$302.00	$416.87	$851.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $194.98 / $194.98	Professional	26	$194.98	$194.98	$194.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $338.84 / $338.84	Professional	TC	$338.84	$338.84	$338.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $1,202.26 / $1,995.26	Professional		$630.96	$1,202.26	$1,995.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $141.25 / $302.00	Professional	26	$100.00	$141.25	$302.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $1,023.29 / $1,778.28	Professional	TC	$501.19	$1,023.29	$1,778.28
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $977.24 / $1,819.70	Professional		$676.08	$977.24	$1,819.70
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $181.97 / $331.13	Professional	26	$131.83	$181.97	$331.13
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $794.33 / $1,445.44	Professional	TC	$537.03	$794.33	$1,445.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $123.03 / $173.78	Facility	26	$26.30	$123.03	$173.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $870.96 / $1,659.59	Professional		$446.68	$870.96	$1,659.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $134.90 / $263.03	Professional	26	$75.86	$134.90	$263.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $707.95 / $1,412.54	Professional	TC	$316.23	$707.95	$1,412.54
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $616.60 / $831.76	Professional		$467.74	$616.60	$831.76
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $120.23 / $162.18	Professional	26	$85.11	$120.23	$162.18
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $501.19 / $676.08	Professional	TC	$389.05	$501.19	$676.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $588.84 / $1,230.27	Professional		$457.09	$588.84	$1,230.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $141.25 / $257.04	Professional	26	$104.71	$141.25	$257.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $575.44 / $977.24	Professional	TC	$416.87	$575.44	$977.24
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $977.24 / $977.24 / $977.24	Facility	26	$977.24	$977.24	$977.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,165.95 / $6,165.95 / $6,165.95	Professional		$6,165.95	$6,165.95	$6,165.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $933.25 / $933.25 / $933.25	Professional	26	$933.25	$933.25	$933.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,623.41 / $5,623.41 / $5,623.41	Professional	TC	$5,623.41	$5,623.41	$5,623.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $128.82 / $549.54	Professional		$32.36	$128.82	$549.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $123.03 / $173.78	Facility	26	$26.30	$123.03	$173.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $933.25 / $1,584.89	Professional		$446.68	$933.25	$1,584.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $128.82 / $234.42	Professional	26	$64.57	$128.82	$234.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $691.83 / $1,412.54	Professional	TC	$309.03	$691.83	$1,412.54
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $1,862.09 / $1,862.09	Professional		$1,862.09	$1,862.09	$1,862.09
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $363.08 / $363.08 / $363.08	Professional	26	$363.08	$363.08	$363.08
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,479.11 / $1,479.11 / $1,479.11	Professional	TC	$1,479.11	$1,479.11	$1,479.11
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $616.60 / $794.33	Professional		$467.74	$616.60	$794.33
United Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $660.69 / $1,412.54	Professional		$478.63	$660.69	$1,412.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $109.65 / $229.09	Professional	26	$83.18	$109.65	$229.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $549.54 / $1,174.90	Professional	TC	$380.19	$549.54	$1,174.90