Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $199.53 / $467.74	Facility	26	$141.25	$199.53	$467.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $478.63 / $1,584.89	Professional		$199.53	$478.63	$1,584.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $141.25 / $407.38	Professional	26	$66.07	$141.25	$407.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $288.40 / $776.25	Professional	TC	$125.89	$288.40	$776.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $309.03 / $501.19	Professional		$194.98	$309.03	$501.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $138.04 / $169.82	Professional	26	$60.26	$138.04	$169.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $457.09 / $741.31	Professional		$309.03	$457.09	$741.31
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $138.04 / $223.87	Professional	26	$93.33	$138.04	$223.87
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $323.59 / $524.81	Professional	TC	$213.80	$323.59	$524.81
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $389.05 / $724.44	Professional		$275.42	$389.05	$724.44
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $114.82 / $208.93	Professional	26	$83.18	$114.82	$208.93
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $275.42 / $512.86	Professional	TC	$190.55	$275.42	$512.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $85.11 / $123.03	Facility	26	$18.62	$85.11	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $316.23 / $660.69	Professional		$173.78	$316.23	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $95.50 / $190.55	Professional	26	$52.48	$95.50	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $208.93 / $446.68	Professional	TC	$120.23	$208.93	$446.68
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $288.40 / $389.05	Professional		$213.80	$288.40	$389.05
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $83.18 / $114.82	Professional	26	$64.57	$83.18	$114.82
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $199.53 / $269.15	Professional	TC	$151.36	$199.53	$269.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $281.84 / $562.34	Professional		$208.93	$281.84	$562.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $100.00 / $177.83	Professional	26	$75.86	$100.00	$177.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $229.09 / $389.05	Professional	TC	$169.82	$229.09	$389.05
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $691.83 / $691.83 / $691.83	Facility	26	$691.83	$691.83	$691.83
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,862.09 / $1,862.09	Professional		$1,479.11	$1,862.09	$1,862.09
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $478.63 / $602.56 / $602.56	Professional	26	$478.63	$602.56	$602.56
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,000.00 / $1,258.93 / $1,258.93	Professional	TC	$1,000.00	$1,258.93	$1,258.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $89.13 / $257.04	Professional		$32.36	$89.13	$257.04
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $85.11 / $123.03	Facility	26	$18.62	$85.11	$123.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $354.81 / $645.65	Professional		$173.78	$354.81	$645.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $87.10 / $169.82	Professional	26	$45.71	$87.10	$169.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $190.55 / $407.38	Professional	TC	$107.15	$190.55	$407.38
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $831.76 / $831.76	Professional		$831.76	$831.76	$831.76
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $263.03 / $263.03	Professional	26	$263.03	$263.03	$263.03
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $575.44 / $575.44	Professional	TC	$575.44	$575.44	$575.44
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $275.42 / $363.08	Professional		$213.80	$275.42	$363.08
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $457.09 / $1,071.52	Professional		$218.78	$457.09	$1,071.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $77.62 / $162.18	Professional	26	$58.88	$77.62	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $316.23 / $912.01	Professional	TC	$147.91	$316.23	$912.01