Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.10 / $111.35 / $687.84	Facility	26	$106.10	$111.35	$687.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $285.07 / $372.32 / $1,739.09	Professional		$285.07	$372.32	$1,739.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.32 / $130.04 / $574.00	Professional	26	$100.32	$130.04	$574.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.16 / $266.22 / $589.19	Professional	TC	$187.16	$266.22	$589.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.43 / $347.35 / $1,742.26	Professional		$204.43	$347.35	$1,742.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $89.55 / $214.62 / $278.26	Professional	26	$89.55	$214.62	$278.26
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $157.93 / $157.93 / $157.93	Professional	TC	$157.93	$157.93	$157.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $339.22 / $524.00 / $1,005.23	Professional		$339.22	$524.00	$1,005.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $109.38 / $147.15 / $301.52	Professional	26	$109.38	$147.15	$301.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $213.04 / $371.56 / $730.88	Professional	TC	$213.04	$371.56	$730.88
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $292.04 / $446.80 / $1,028.44	Professional		$292.04	$446.80	$1,028.44
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $142.12 / $344.85	Professional	26	$100.00	$142.12	$344.85
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $196.53 / $301.14 / $676.89	Professional	TC	$196.53	$301.14	$676.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.94 / $128.94 / $128.94	Facility	26	$128.94	$128.94	$128.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $276.89 / $573.79 / $1,182.56	Professional		$276.89	$573.79	$1,182.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.29 / $134.27 / $314.89	Professional	26	$66.29	$134.27	$314.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $196.00 / $418.69 / $876.35	Professional	TC	$196.00	$418.69	$876.35
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $312.13 / $420.92 / $568.24	Professional		$312.13	$420.92	$568.24
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.28 / $125.21 / $169.03	Professional	26	$84.28	$125.21	$169.03
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $227.85 / $295.70 / $399.21	Professional	TC	$227.85	$295.70	$399.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $306.64 / $420.47 / $749.58	Professional		$306.64	$420.47	$749.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $110.94 / $150.25 / $235.39	Professional	26	$110.94	$150.25	$235.39
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $228.06 / $342.09 / $554.66	Professional	TC	$228.06	$342.09	$554.66
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,034.56 / $1,034.56 / $1,056.00	Facility	26	$1,034.56	$1,034.56	$1,056.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,091.94 / $2,091.94 / $2,743.65	Professional		$2,091.94	$2,091.94	$2,743.65
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $711.82 / $711.82 / $908.70	Professional	26	$711.82	$711.82	$908.70
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,773.11 / $1,773.11 / $1,834.95	Professional	TC	$1,773.11	$1,773.11	$1,834.95
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $204.12	Professional		$32.34	$32.34	$204.12
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $128.94 / $128.94 / $128.94	Facility	26	$128.94	$128.94	$128.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $300.00 / $630.54 / $1,047.84	Professional		$300.00	$630.54	$1,047.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.28 / $128.96 / $305.11	Professional	26	$66.28	$128.96	$305.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $196.00 / $422.26 / $851.20	Professional	TC	$196.00	$422.26	$851.20
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,199.07 / $1,199.07 / $1,199.07	Professional		$1,199.07	$1,199.07	$1,199.07
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $385.67 / $385.67 / $385.67	Professional	26	$385.67	$385.67	$385.67
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $813.39 / $813.39 / $813.39	Professional	TC	$813.39	$813.39	$813.39
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $340.39 / $436.99 / $530.62	Professional		$340.39	$436.99	$530.62
United Facility/Professional Professional Modifier Low / Median / High Price $310.75 / $499.50 / $1,102.18	Professional		$310.75	$499.50	$1,102.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.51 / $122.30 / $298.77	Professional	26	$91.51	$122.30	$298.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $207.98 / $346.29 / $788.56	Professional	TC	$207.98	$346.29	$788.56