Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $177.83 / $478.63	Facility	26	$107.15	$177.83	$478.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $398.11 / $1,862.09	Professional		$275.42	$398.11	$1,862.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $181.97 / $588.84	Professional	26	$104.71	$181.97	$588.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $269.15 / $676.08	Professional	TC	$169.82	$269.15	$676.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $331.13 / $660.69	Professional		$281.84	$331.13	$660.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $213.80 / $263.03	Professional	26	$117.49	$213.80	$263.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $158.49 / $173.78	Professional	TC	$158.49	$158.49	$173.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $562.34 / $1,047.13	Professional		$371.54	$562.34	$1,047.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $158.49 / $309.03	Professional	26	$114.82	$158.49	$309.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $407.38 / $758.58	Professional	TC	$263.03	$407.38	$758.58
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $588.84 / $1,047.13	Professional		$416.87	$588.84	$1,047.13
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $186.21 / $346.74	Professional	26	$134.90	$186.21	$346.74
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $389.05 / $691.83	Professional	TC	$281.84	$389.05	$691.83
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 $281.84 / $562.34 / $1,047.13	Professional		$281.84	$562.34	$1,047.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $134.90 / $269.15	Professional	26	$79.43	$134.90	$269.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $407.38 / $812.83	Professional	TC	$194.98	$407.38	$812.83
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $426.58 / $575.44	Professional		$309.03	$426.58	$575.44
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $125.89 / $173.78	Professional	26	$85.11	$125.89	$173.78
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $302.00 / $407.38	Professional	TC	$229.09	$302.00	$407.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $407.38 / $794.33	Professional		$316.23	$407.38	$794.33
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 $251.19 / $323.59 / $562.34	Professional	TC	$251.19	$323.59	$562.34
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,023.29 / $1,023.29 / $1,023.29	Facility	26	$1,023.29	$1,023.29	$1,023.29
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,089.30 / $2,754.23 / $2,754.23	Professional		$2,089.30	$2,754.23	$2,754.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $707.95 / $912.01 / $912.01	Professional	26	$707.95	$912.01	$912.01
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,778.28 / $1,819.70 / $1,819.70	Professional	TC	$1,778.28	$1,819.70	$1,819.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $134.90 / $371.54	Professional		$32.36	$134.90	$371.54
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 $281.84 / $602.56 / $954.99	Professional		$281.84	$602.56	$954.99
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $123.03 / $245.47	Professional	26	$67.61	$123.03	$245.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $389.05 / $758.58	Professional	TC	$190.55	$389.05	$758.58
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,202.26 / $1,202.26	Professional		$1,202.26	$1,202.26	$1,202.26
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 $812.83 / $812.83 / $812.83	Professional	TC	$812.83	$812.83	$812.83
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $407.38 / $524.81	Professional		$309.03	$407.38	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $478.63 / $954.99	Professional		$309.03	$478.63	$954.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $114.82 / $245.47	Professional	26	$91.20	$114.82	$245.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $323.59 / $741.31	Professional	TC	$208.93	$323.59	$741.31