Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $331.13 / $758.58	Facility	26	$141.25	$331.13	$758.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $602.56 / $2,691.53	Professional		$389.05	$602.56	$2,691.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $257.04 / $645.65	Professional	26	$123.03	$257.04	$645.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $346.74 / $870.96	Professional	TC	$257.04	$346.74	$870.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $630.96 / $707.95	Professional		$229.09	$630.96	$707.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $199.53 / $676.08	Professional	26	$128.82	$199.53	$676.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $891.25 / $1,513.56	Professional		$537.03	$891.25	$1,513.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $173.78 / $346.74	Professional	26	$123.03	$173.78	$346.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $707.95 / $1,174.90	Professional	TC	$398.11	$707.95	$1,174.90
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $707.95 / $1,318.26	Professional		$501.19	$707.95	$1,318.26
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $204.17 / $371.54	Professional	26	$147.91	$204.17	$371.54
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $512.86 / $954.99	Professional	TC	$354.81	$512.86	$954.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $138.04 / $199.53	Facility	26	$30.20	$138.04	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $645.65 / $1,230.27	Professional		$338.84	$645.65	$1,230.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $147.91 / $302.00	Professional	26	$85.11	$147.91	$302.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $467.74 / $912.01	Professional	TC	$239.88	$467.74	$912.01
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $478.63 / $645.65	Professional		$363.08	$478.63	$645.65
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $138.04 / $186.21	Professional	26	$104.71	$138.04	$186.21
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $346.74 / $467.74	Professional	TC	$257.04	$346.74	$467.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $467.74 / $933.25	Professional		$354.81	$467.74	$933.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $162.18 / $288.40	Professional	26	$123.03	$162.18	$288.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $389.05 / $660.69	Professional	TC	$288.40	$389.05	$660.69
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,122.02 / $1,122.02 / $1,122.02	Facility	26	$1,122.02	$1,122.02	$1,122.02
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,073.80 / $4,073.80 / $4,073.80	Professional		$4,073.80	$4,073.80	$4,073.80
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $776.25 / $977.24 / $977.24	Professional	26	$776.25	$977.24	$977.24
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,388.44 / $3,388.44 / $3,388.44	Professional	TC	$3,388.44	$3,388.44	$3,388.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $144.54 / $426.58	Professional		$32.36	$144.54	$426.58
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $138.04 / $199.53	Facility	26	$30.20	$138.04	$199.53
Providence Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $691.83 / $1,122.02	Professional		$346.74	$691.83	$1,122.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $138.04 / $269.15	Professional	26	$75.86	$138.04	$269.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $457.09 / $891.25	Professional	TC	$223.87	$457.09	$891.25
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,412.54 / $1,412.54	Professional		$1,412.54	$1,412.54	$1,412.54
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $416.87 / $416.87 / $416.87	Professional	26	$416.87	$416.87	$416.87
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $977.24 / $977.24 / $977.24	Professional	TC	$977.24	$977.24	$977.24
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $467.74 / $616.60	Professional		$363.08	$467.74	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $489.78 / $1,047.13	Professional		$363.08	$489.78	$1,047.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $123.03 / $263.03	Professional	26	$97.72	$123.03	$263.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $354.81 / $776.25	Professional	TC	$251.19	$354.81	$776.25