Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.14 / $140.00 / $665.28	Facility	26	$112.14	$140.00	$665.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.50 / $488.36 / $2,350.60	Professional		$370.50	$488.36	$2,350.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $113.31 / $176.40 / $567.02	Professional	26	$113.31	$176.40	$567.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $250.93 / $335.00 / $720.62	Professional	TC	$250.93	$335.00	$720.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $268.86 / $399.39 / $717.83	Professional		$268.86	$399.39	$717.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $82.30 / $123.35 / $267.89	Professional	26	$82.30	$123.35	$267.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $404.55 / $851.98 / $1,767.62	Professional		$404.55	$851.98	$1,767.62
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $114.10 / $159.69 / $319.92	Professional	26	$114.10	$159.69	$319.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $277.79 / $691.96 / $1,519.12	Professional	TC	$277.79	$691.96	$1,519.12
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $313.88 / $481.24 / $1,174.17	Professional		$313.88	$481.24	$1,174.17
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $137.94 / $335.23	Professional	26	$100.00	$137.94	$335.23
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $221.31 / $344.46 / $826.39	Professional	TC	$221.31	$344.46	$826.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.77 / $659.23 / $1,560.99	Professional		$302.77	$659.23	$1,560.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.98 / $137.76 / $307.88	Professional	26	$65.98	$137.76	$307.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $210.04 / $469.40 / $1,338.91	Professional	TC	$210.04	$469.40	$1,338.91
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $313.58 / $418.42 / $564.87	Professional		$313.58	$418.42	$564.87
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.94 / $120.56 / $162.76	Professional	26	$90.94	$120.56	$162.76
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $222.64 / $297.86 / $402.11	Professional	TC	$222.64	$297.86	$402.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $326.77 / $435.70 / $809.00	Professional		$326.77	$435.70	$809.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $108.50 / $156.24 / $400.00	Professional	26	$108.50	$156.24	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $253.96 / $349.35 / $685.08	Professional	TC	$253.96	$349.35	$685.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $996.56 / $996.56 / $1,016.96	Facility	26	$996.56	$996.56	$1,016.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,195.24 / $6,381.10 / $6,381.10	Professional		$6,195.24	$6,381.10	$6,381.10
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $931.20 / $931.20 / $931.20	Professional	26	$931.20	$931.20	$931.20
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,551.18 / $5,717.71 / $5,717.71	Professional	TC	$5,551.18	$5,717.71	$5,717.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $249.49	Professional		$32.34	$32.34	$249.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $315.48 / $725.38 / $1,470.65	Professional		$315.48	$725.38	$1,470.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $65.88 / $135.78 / $304.58	Professional	26	$65.88	$135.78	$304.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $193.03 / $488.53 / $1,338.91	Professional	TC	$193.03	$488.53	$1,338.91
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,227.91 / $1,227.91 / $1,227.91	Professional		$1,227.91	$1,227.91	$1,227.91
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $373.09 / $373.09 / $373.09	Professional	26	$373.09	$373.09	$373.09
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $854.82 / $854.82 / $854.82	Professional	TC	$854.82	$854.82	$854.82
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $338.37 / $465.26 / $2,368.34	Professional		$338.37	$465.26	$2,368.34
United Facility/Professional Professional Modifier Low / Median / High Price $318.11 / $525.44 / $1,389.07	Professional		$318.11	$525.44	$1,389.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.64 / $128.88 / $277.33	Professional	26	$97.64	$128.88	$277.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.41 / $400.36 / $947.11	Professional	TC	$218.41	$400.36	$947.11