Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $213.80 / $489.78	Facility	26	$141.25	$213.80	$489.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $549.54 / $2,754.23	Professional		$251.19	$549.54	$2,754.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $186.21 / $537.03	Professional	26	$102.33	$186.21	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $436.52 / $1,905.46	Professional	TC	$316.23	$436.52	$1,905.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $691.83 / $1,230.27	Professional		$323.59	$691.83	$1,230.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $177.83 / $229.09	Professional	26	$83.18	$177.83	$229.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $831.76 / $1,737.80	Professional		$549.54	$831.76	$1,737.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $131.83 / $288.40	Professional	26	$97.72	$131.83	$288.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $707.95 / $1,445.44	Professional	TC	$446.68	$707.95	$1,445.44
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $851.14 / $1,584.89	Professional		$588.84	$851.14	$1,584.89
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $169.82 / $316.23	Professional	26	$123.03	$169.82	$316.23
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $676.08 / $1,258.93	Professional	TC	$467.74	$676.08	$1,258.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $758.58 / $1,513.56	Professional		$398.11	$758.58	$1,513.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $128.82 / $251.19	Professional	26	$72.44	$128.82	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $602.56 / $1,348.96	Professional	TC	$309.03	$602.56	$1,348.96
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $549.54 / $741.31	Professional		$389.05	$549.54	$741.31
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $114.82 / $154.88	Professional	26	$77.62	$114.82	$154.88
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $436.52 / $588.84	Professional	TC	$309.03	$436.52	$588.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $524.81 / $1,047.13	Professional		$398.11	$524.81	$1,047.13
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 $354.81 / $489.78 / $831.76	Professional	TC	$354.81	$489.78	$831.76
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $933.25 / $933.25 / $933.25	Facility	26	$933.25	$933.25	$933.25
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 $676.08 / $831.76 / $831.76	Professional	26	$676.08	$831.76	$831.76
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 / $120.23 / $478.63	Professional		$32.36	$120.23	$478.63
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $812.83 / $1,445.44	Professional		$398.11	$812.83	$1,445.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $123.03 / $223.87	Professional	26	$61.66	$123.03	$223.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $588.84 / $1,380.38	Professional	TC	$302.00	$588.84	$1,380.38
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,584.89 / $1,584.89	Professional		$1,584.89	$1,584.89	$1,584.89
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $346.74 / $346.74 / $346.74	Professional	26	$346.74	$346.74	$346.74
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,258.93 / $1,258.93 / $1,258.93	Professional	TC	$1,258.93	$1,258.93	$1,258.93
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $616.60 / $954.99	Professional		$446.68	$616.60	$954.99
United Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $575.44 / $1,288.25	Professional		$416.87	$575.44	$1,288.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $104.71 / $218.78	Professional	26	$79.43	$104.71	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $478.63 / $1,071.52	Professional	TC	$323.59	$478.63	$1,071.52