Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $190.55 / $524.81	Facility	26	$141.25	$190.55	$524.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $602.56 / $2,089.30	Professional		$363.08	$602.56	$2,089.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $181.97 / $575.44	Professional	26	$104.71	$181.97	$575.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $338.84 / $1,230.27	Professional	TC	$218.78	$338.84	$1,230.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $346.74 / $758.58	Professional		$263.03	$346.74	$758.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $218.78 / $257.04	Professional	26	$102.33	$218.78	$257.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	TC	$151.36	$151.36	$151.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $724.44 / $1,174.90	Professional		$467.74	$724.44	$1,174.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $194.98 / $323.59	Professional	26	$134.90	$194.98	$323.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $524.81 / $851.14	Professional	TC	$331.13	$524.81	$851.14
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $616.60 / $1,148.15	Professional		$436.52	$616.60	$1,148.15
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $165.96 / $302.00	Professional	26	$120.23	$165.96	$302.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $446.68 / $831.76	Professional	TC	$316.23	$446.68	$831.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $125.89 / $177.83	Facility	26	$26.92	$125.89	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $478.63 / $1,047.13	Professional		$275.42	$478.63	$1,047.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $134.90 / $275.42	Professional	26	$75.86	$134.90	$275.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $338.84 / $724.44	Professional	TC	$194.98	$338.84	$724.44
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $446.68 / $602.56	Professional		$338.84	$446.68	$602.56
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $120.23 / $162.18	Professional	26	$91.20	$120.23	$162.18
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $331.13 / $446.68	Professional	TC	$245.47	$331.13	$446.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $426.58 / $851.14	Professional		$331.13	$426.58	$851.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $144.54 / $257.04	Professional	26	$109.65	$144.54	$257.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $371.54 / $630.96	Professional	TC	$275.42	$371.54	$630.96
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Facility	26	$1,000.00	$1,000.00	$1,000.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,344.23 / $2,884.03 / $2,884.03	Professional		$2,344.23	$2,884.03	$2,884.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $691.83 / $891.25 / $891.25	Professional	26	$691.83	$891.25	$891.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,659.59 / $2,041.74 / $2,041.74	Professional	TC	$1,659.59	$2,041.74	$2,041.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $128.82 / $407.38	Professional		$32.36	$128.82	$407.38
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $125.89 / $177.83	Facility	26	$26.92	$125.89	$177.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $501.19 / $1,023.29	Professional		$263.03	$501.19	$1,023.29
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $125.89 / $245.47	Professional	26	$66.07	$125.89	$245.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $316.23 / $676.08	Professional	TC	$173.78	$316.23	$676.08
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,318.26	Professional		$1,318.26	$1,318.26	$1,318.26
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $371.54 / $371.54 / $371.54	Professional	26	$371.54	$371.54	$371.54
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $954.99 / $954.99 / $954.99	Professional	TC	$954.99	$954.99	$954.99
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $436.52 / $575.44	Professional		$338.84	$436.52	$575.44
United Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $562.34 / $1,230.27	Professional		$346.74	$562.34	$1,230.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $234.42	Professional	26	$66.07	$100.00	$234.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $426.58 / $1,023.29	Professional	TC	$245.47	$426.58	$1,023.29