Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $208.93 / $478.63	Facility	26	$141.25	$208.93	$478.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $549.54 / $2,137.96	Professional		$323.59	$549.54	$2,137.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $154.88 / $407.38	Professional	26	$79.43	$154.88	$407.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $363.08 / $794.33	Professional	TC	$263.03	$363.08	$794.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $616.60 / $1,698.24	Professional		$275.42	$616.60	$1,698.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $141.25 / $173.78	Professional	26	$72.44	$141.25	$173.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $213.80 / $213.80	Professional	TC	$213.80	$213.80	$213.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $741.31 / $1,318.26	Professional		$446.68	$741.31	$1,318.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $97.72 / $213.80	Professional	26	$69.18	$97.72	$213.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $660.69 / $1,071.52	Professional	TC	$363.08	$660.69	$1,071.52
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $645.65 / $1,202.26	Professional		$457.09	$645.65	$1,202.26
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $128.82 / $239.88	Professional	26	$93.33	$128.82	$239.88
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $524.81 / $977.24	Professional	TC	$354.81	$524.81	$977.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $87.10 / $125.89	Facility	26	$18.62	$87.10	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $562.34 / $1,047.13	Professional		$288.40	$562.34	$1,047.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $97.72 / $190.55	Professional	26	$54.95	$97.72	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $446.68 / $870.96	Professional	TC	$239.88	$446.68	$870.96
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $426.58 / $575.44	Professional		$316.23	$426.58	$575.44
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $87.10 / $117.49	Professional	26	$63.10	$87.10	$117.49
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $338.84 / $457.09	Professional	TC	$251.19	$338.84	$457.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $416.87 / $794.33	Professional		$309.03	$416.87	$794.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $104.71 / $190.55	Professional	26	$77.62	$104.71	$190.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $389.05 / $645.65	Professional	TC	$281.84	$389.05	$645.65
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $707.95 / $707.95 / $707.95	Facility	26	$707.95	$707.95	$707.95
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,467.37 / $3,467.37 / $3,467.37	Professional		$3,467.37	$3,467.37	$3,467.37
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $602.56 / $616.60 / $616.60	Professional	26	$602.56	$616.60	$616.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,019.95 / $3,019.95 / $3,019.95	Professional	TC	$3,019.95	$3,019.95	$3,019.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $91.20 / $371.54	Professional		$32.36	$91.20	$371.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $87.10 / $125.89	Facility	26	$18.62	$87.10	$125.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $602.56 / $954.99	Professional		$302.00	$602.56	$954.99
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $93.33 / $173.78	Professional	26	$46.77	$93.33	$173.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $426.58 / $831.76	Professional	TC	$234.42	$426.58	$831.76
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Professional		$1,230.27	$1,230.27	$1,230.27
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $263.03 / $263.03	Professional	26	$263.03	$263.03	$263.03
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 $316.23 / $407.38 / $537.03	Professional		$316.23	$407.38	$537.03
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $446.68 / $891.25	Professional		$316.23	$446.68	$891.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $79.43 / $165.96	Professional	26	$60.26	$79.43	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $354.81 / $741.31	Professional	TC	$245.47	$354.81	$741.31