Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.81 / $116.34 / $684.35	Facility	26	$110.81	$116.34	$684.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.58 / $461.44 / $1,336.02	Professional		$295.58	$461.44	$1,336.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.37 / $122.79 / $525.66	Professional	26	$104.37	$122.79	$525.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.85 / $350.63 / $762.93	Professional	TC	$186.85	$350.63	$762.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $261.02 / $421.73 / $435.05	Professional		$261.02	$421.73	$435.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $82.72 / $110.08 / $538.00	Professional	26	$82.72	$110.08	$538.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $250.48 / $250.48 / $250.48	Professional	TC	$250.48	$250.48	$250.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $276.35 / $579.33 / $1,265.67	Professional		$276.35	$579.33	$1,265.67
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.21 / $148.18 / $300.29	Professional	26	$94.21	$148.18	$300.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $188.76 / $431.15 / $982.16	Professional	TC	$188.76	$431.15	$982.16
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $292.88 / $448.25 / $1,112.99	Professional		$292.88	$448.25	$1,112.99
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $143.30 / $341.61	Professional	26	$100.00	$143.30	$341.61
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $196.71 / $301.49 / $774.87	Professional	TC	$196.71	$301.49	$774.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $289.31 / $622.89 / $1,319.90	Professional		$289.31	$622.89	$1,319.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.43 / $133.44 / $313.31	Professional	26	$68.43	$133.44	$313.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $224.00 / $466.23 / $1,017.66	Professional	TC	$224.00	$466.23	$1,017.66
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $342.54 / $375.33 / $506.70	Professional		$342.54	$375.33	$506.70
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.76 / $123.51 / $166.74	Professional	26	$102.76	$123.51	$166.74
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $239.78 / $251.82 / $339.96	Professional	TC	$239.78	$251.82	$339.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $398.30 / $538.88 / $923.36	Professional		$398.30	$538.88	$923.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.71 / $148.21 / $232.20	Professional	26	$109.71	$148.21	$232.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $323.51 / $485.27 / $786.88	Professional	TC	$323.51	$485.27	$786.88
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,024.72 / $1,024.72 / $1,048.24	Facility	26	$1,024.72	$1,024.72	$1,048.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,801.00 / $4,801.00 / $4,801.00	Professional		$4,801.00	$4,801.00	$4,801.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,632.94 / $1,632.94 / $1,632.94	Professional	26	$1,632.94	$1,632.94	$1,632.94
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,601.00 / $3,601.00 / $3,601.00	Professional	TC	$3,601.00	$3,601.00	$3,601.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $345.23	Professional		$32.34	$32.34	$345.23
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $311.44 / $728.38 / $1,212.66	Professional		$311.44	$728.38	$1,212.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $68.13 / $128.13 / $291.43	Professional	26	$68.13	$128.13	$291.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $210.00 / $456.03 / $972.37	Professional	TC	$210.00	$456.03	$972.37
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,481.66 / $1,481.66 / $1,481.66	Professional		$1,481.66	$1,481.66	$1,481.66
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $384.56 / $384.56 / $384.56	Professional	26	$384.56	$384.56	$384.56
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,097.09 / $1,097.09 / $1,097.09	Professional	TC	$1,097.09	$1,097.09	$1,097.09
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $303.52 / $417.34 / $582.32	Professional		$303.52	$417.34	$582.32
United Facility/Professional Professional Modifier Low / Median / High Price $383.15 / $495.84 / $1,215.04	Professional		$383.15	$495.84	$1,215.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.80 / $120.90 / $284.37	Professional	26	$93.80	$120.90	$284.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $280.38 / $408.11 / $925.22	Professional	TC	$280.38	$408.11	$925.22