Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $302.00 / $707.95	Facility	26	$107.15	$302.00	$707.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $309.03 / $1,318.26	Professional		$204.17	$309.03	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $128.82 / $446.68	Professional	26	$87.10	$128.82	$446.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $177.83 / $478.63	Professional	TC	$100.00	$177.83	$478.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $309.03 / $309.03	Professional		$309.03	$309.03	$309.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $257.04 / $257.04 / $257.04	Professional	26	$257.04	$257.04	$257.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $467.74 / $1,047.13	Professional		$309.03	$467.74	$1,047.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $154.88 / $323.59	Professional	26	$112.20	$154.88	$323.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $316.23 / $794.33	Professional	TC	$194.98	$316.23	$794.33
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $389.05 / $758.58	Professional		$275.42	$389.05	$758.58
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $190.55 / $354.81	Professional	26	$138.04	$190.55	$354.81
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $199.53 / $398.11	Professional	TC	$134.90	$199.53	$398.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $128.82 / $186.21	Facility	26	$27.54	$128.82	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $524.81 / $1,148.15	Professional		$275.42	$524.81	$1,148.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $128.82 / $275.42	Professional	26	$66.07	$128.82	$275.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $398.11 / $891.25	Professional	TC	$199.53	$398.11	$891.25
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $371.54 / $416.87	Professional		$275.42	$371.54	$416.87
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $125.89 / $169.82	Professional	26	$83.18	$125.89	$169.82
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $204.17 / $331.13	Professional	TC	$151.36	$204.17	$331.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $512.86 / $954.99	Professional		$398.11	$512.86	$954.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $147.91 / $239.88	Professional	26	$112.20	$147.91	$239.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $446.68 / $794.33	Professional	TC	$346.74	$446.68	$794.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,047.13 / $1,047.13 / $1,047.13	Facility	26	$1,047.13	$1,047.13	$1,047.13
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $1,862.09 / $1,995.26	Professional		$1,862.09	$1,862.09	$1,995.26
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $724.44 / $912.01 / $912.01	Professional	26	$724.44	$912.01	$912.01
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,348.96 / $1,348.96 / $1,479.11	Professional	TC	$1,348.96	$1,348.96	$1,479.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $134.90 / $489.78	Professional		$32.36	$134.90	$489.78
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $128.82 / $186.21	Facility	26	$27.54	$128.82	$186.21
Providence Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $549.54 / $1,148.15	Professional		$263.03	$549.54	$1,148.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $117.49 / $239.88	Professional	26	$63.10	$117.49	$239.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $363.08 / $776.25	Professional	TC	$194.98	$363.08	$776.25
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 $389.05 / $389.05 / $389.05	Professional	26	$389.05	$389.05	$389.05
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,202.26 / $1,202.26 / $1,202.26	Professional	TC	$1,202.26	$1,202.26	$1,202.26
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $416.87 / $707.95	Professional		$223.87	$416.87	$707.95
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $457.09 / $1,023.29	Professional		$323.59	$457.09	$1,023.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $114.82 / $245.47	Professional	26	$87.10	$114.82	$245.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $338.84 / $776.25	Professional	TC	$234.42	$338.84	$776.25