Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $223.87 / $524.81	Facility	26	$141.25	$223.87	$524.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $478.63 / $1,819.70	Professional		$295.12	$478.63	$1,819.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $501.19	Professional	26	$85.11	$141.25	$501.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $338.84 / $812.83	Professional	TC	$199.53	$338.84	$812.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $467.74 / $645.65	Professional		$389.05	$467.74	$645.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	26	$109.65	$109.65	$109.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $758.58 / $1,258.93	Professional		$457.09	$758.58	$1,258.93
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $134.90 / $251.19	Professional	26	$93.33	$134.90	$251.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $630.96 / $1,000.00	Professional	TC	$331.13	$630.96	$1,000.00
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $549.54 / $1,023.29	Professional		$380.19	$549.54	$1,023.29
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $141.25 / $263.03	Professional	26	$102.33	$141.25	$263.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $407.38 / $758.58	Professional	TC	$281.84	$407.38	$758.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $537.03 / $1,023.29	Professional		$269.15	$537.03	$1,023.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $112.20 / $218.78	Professional	26	$60.26	$112.20	$218.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $407.38 / $812.83	Professional	TC	$190.55	$407.38	$812.83
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $363.08 / $489.78	Professional		$269.15	$363.08	$489.78
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $95.50 / $128.82	Professional	26	$70.79	$95.50	$128.82
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $269.15 / $363.08	Professional	TC	$199.53	$269.15	$363.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $363.08 / $707.95	Professional		$269.15	$363.08	$707.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $114.82 / $208.93	Professional	26	$85.11	$114.82	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $309.03 / $524.81	Professional	TC	$223.87	$309.03	$524.81
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,548.13 / $3,548.13 / $3,548.13	Professional		$3,548.13	$3,548.13	$3,548.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $645.65 / $691.83 / $691.83	Professional	26	$645.65	$691.83	$691.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,090.30 / $3,090.30 / $3,090.30	Professional	TC	$3,090.30	$3,090.30	$3,090.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $102.33 / $323.59	Professional		$32.36	$102.33	$323.59
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $562.34 / $933.25	Professional		$269.15	$562.34	$933.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $107.15 / $186.21	Professional	26	$54.95	$107.15	$186.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $398.11 / $812.83	Professional	TC	$186.21	$398.11	$812.83
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,047.13 / $1,047.13	Professional		$1,047.13	$1,047.13	$1,047.13
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	26	$288.40	$288.40	$288.40
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $758.58 / $758.58 / $758.58	Professional	TC	$758.58	$758.58	$758.58
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $407.38 / $1,659.59	Professional		$295.12	$407.38	$1,659.59
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $436.52 / $891.25	Professional		$275.42	$436.52	$891.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $89.13 / $181.97	Professional	26	$69.18	$89.13	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $323.59 / $707.95	Professional	TC	$194.98	$323.59	$707.95