Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $190.55 / $389.05	Facility	26	$141.25	$190.55	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $602.56 / $2,570.40	Professional		$354.81	$602.56	$2,570.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $199.53 / $549.54	Professional	26	$102.33	$199.53	$549.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $389.05 / $1,584.89	Professional	TC	$257.04	$389.05	$1,584.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $338.84 / $794.33	Professional		$213.80	$338.84	$794.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $190.55 / $257.04	Professional	26	$107.15	$190.55	$257.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $251.19 / $316.23	Professional	TC	$190.55	$251.19	$316.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $1,122.02 / $1,862.09	Professional		$537.03	$1,122.02	$1,862.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $134.90 / $295.12	Professional	26	$100.00	$134.90	$295.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $407.38 / $912.01 / $1,659.59	Professional	TC	$407.38	$912.01	$1,659.59
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $851.14 / $1,513.56	Professional		$602.56	$851.14	$1,513.56
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 $467.74 / $676.08 / $1,202.26	Professional	TC	$467.74	$676.08	$1,202.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $120.23 / $169.82	Facility	26	$25.70	$120.23	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $707.95 / $1,479.11	Professional		$338.84	$707.95	$1,479.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $131.83 / $257.04	Professional	26	$74.13	$131.83	$257.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $524.81 / $1,288.25	Professional	TC	$245.47	$524.81	$1,288.25
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $446.68 / $602.56	Professional		$331.13	$446.68	$602.56
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $117.49 / $158.49	Professional	26	$69.18	$117.49	$158.49
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $323.59 / $446.68	Professional	TC	$263.03	$323.59	$446.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $436.52 / $794.33	Professional		$323.59	$436.52	$794.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $138.04 / $251.19	Professional	26	$102.33	$138.04	$251.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $371.54 / $630.96	Professional	TC	$275.42	$371.54	$630.96
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $954.99 / $954.99 / $954.99	Facility	26	$954.99	$954.99	$954.99
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 $891.25 / $891.25 / $891.25	Professional	26	$891.25	$891.25	$891.25
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 / $123.03 / $467.74	Professional		$32.36	$123.03	$467.74
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $120.23 / $169.82	Facility	26	$25.70	$120.23	$169.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $707.95 / $1,479.11	Professional		$338.84	$707.95	$1,479.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $128.82 / $223.87	Professional	26	$64.57	$128.82	$223.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $524.81 / $1,318.26	Professional	TC	$245.47	$524.81	$1,318.26
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,318.26	Professional		$1,318.26	$1,318.26	$1,318.26
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $354.81 / $354.81 / $354.81	Professional	26	$354.81	$354.81	$354.81
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $954.99 / $954.99 / $954.99	Professional	TC	$954.99	$954.99	$954.99
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $436.52 / $562.34	Professional		$331.13	$436.52	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $562.34 / $1,174.90	Professional		$338.84	$562.34	$1,174.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $107.15 / $223.87	Professional	26	$83.18	$107.15	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $407.38 / $977.24	Professional	TC	$239.88	$407.38	$977.24