Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $123.03 / $281.84	Facility	26	$93.33	$123.03	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $588.84 / $2,398.83	Professional		$380.19	$588.84	$2,398.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $141.25 / $489.78	Professional	26	$91.20	$141.25	$489.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $446.68 / $933.25	Professional	TC	$269.15	$446.68	$933.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $436.52 / $1,071.52	Professional		$239.88	$436.52	$1,071.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $165.96 / $234.42	Professional	26	$85.11	$165.96	$234.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $851.14 / $1,412.54	Professional		$512.86	$851.14	$1,412.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $144.54 / $295.12	Professional	26	$107.15	$144.54	$295.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $691.83 / $1,122.02	Professional	TC	$398.11	$691.83	$1,122.02
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $660.69 / $1,258.93	Professional		$457.09	$660.69	$1,258.93
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $173.78 / $316.23	Professional	26	$125.89	$173.78	$316.23
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $489.78 / $912.01	Professional	TC	$331.13	$489.78	$912.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $117.49 / $169.82	Facility	26	$25.70	$117.49	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $588.84 / $1,148.15	Professional		$302.00	$588.84	$1,148.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $128.82 / $257.04	Professional	26	$72.44	$128.82	$257.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $467.74 / $912.01	Professional	TC	$229.09	$467.74	$912.01
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $501.19 / $676.08	Professional		$354.81	$501.19	$676.08
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $114.82 / $154.88	Professional	26	$95.50	$114.82	$154.88
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $389.05 / $524.81	Professional	TC	$257.04	$389.05	$524.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $478.63 / $933.25	Professional		$371.54	$478.63	$933.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $131.83 / $218.78	Professional	26	$102.33	$131.83	$218.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $416.87 / $741.31	Professional	TC	$323.59	$416.87	$741.31
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 $758.58 / $3,235.94 / $3,235.94	Professional		$758.58	$3,235.94	$3,235.94
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $660.69 / $831.76 / $831.76	Professional	26	$660.69	$831.76	$831.76
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,089.30 / $2,398.83 / $2,398.83	Professional	TC	$2,089.30	$2,398.83	$2,398.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $123.03 / $446.68	Professional		$32.36	$123.03	$446.68
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $117.49 / $169.82	Facility	26	$25.70	$117.49	$169.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $630.96 / $1,071.52	Professional		$302.00	$630.96	$1,071.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $117.49 / $223.87	Professional	26	$63.10	$117.49	$223.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $426.58 / $851.14	Professional	TC	$204.17	$426.58	$851.14
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,348.96 / $1,348.96	Professional		$1,348.96	$1,348.96	$1,348.96
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 $1,000.00 / $1,000.00 / $1,000.00	Professional	TC	$1,000.00	$1,000.00	$1,000.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $467.74 / $602.56	Professional		$354.81	$467.74	$602.56
United Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $467.74 / $977.24	Professional		$346.74	$467.74	$977.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $107.15 / $223.87	Professional	26	$85.11	$107.15	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $371.54 / $741.31	Professional	TC	$257.04	$371.54	$741.31