Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.88 / $75.54 / $491.73	Facility	26	$71.88	$75.54	$491.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $481.64 / $615.03 / $2,374.00	Professional		$481.64	$615.03	$2,374.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.33 / $97.37 / $389.12	Professional	26	$70.33	$97.37	$389.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $394.43 / $508.06 / $2,094.00	Professional	TC	$394.43	$508.06	$2,094.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $401.15 / $509.10 / $1,013.11	Professional		$401.15	$509.10	$1,013.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $78.42 / $139.50 / $190.81	Professional	26	$78.42	$139.50	$190.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $414.66 / $625.14 / $1,363.55	Professional		$414.66	$625.14	$1,363.55
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.36 / $104.39 / $221.02	Professional	26	$83.36	$104.39	$221.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $320.08 / $519.94 / $1,153.48	Professional	TC	$320.08	$519.94	$1,153.48
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $352.48 / $517.16 / $1,259.09	Professional		$352.48	$517.16	$1,259.09
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.92 / $73.65 / $182.69	Professional	26	$60.92	$73.65	$182.69
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $301.58 / $444.78 / $1,077.29	Professional	TC	$301.58	$444.78	$1,077.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $409.89 / $618.74 / $1,543.64	Professional		$409.89	$618.74	$1,543.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.98 / $98.87 / $226.09	Professional	26	$69.98	$98.87	$226.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $335.50 / $538.59 / $1,322.01	Professional	TC	$335.50	$538.59	$1,322.01
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $155.88 / $587.26 / $792.80	Professional		$155.88	$587.26	$792.80
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.38 / $95.24 / $128.57	Professional	26	$23.38	$95.24	$128.57
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $132.51 / $492.02 / $664.23	Professional	TC	$132.51	$492.02	$664.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $446.76 / $587.26 / $1,103.17	Professional		$446.76	$587.26	$1,103.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.76 / $117.69 / $196.47	Professional	26	$81.76	$117.69	$196.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $379.19 / $576.91 / $925.00	Professional	TC	$379.19	$576.91	$925.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $192.44 / $1,357.70 / $1,357.70	Facility	26	$192.44	$1,357.70	$1,357.70
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $4,499.00 / $4,499.00 / $4,499.00	Professional		$4,499.00	$4,499.00	$4,499.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,350.00 / $1,350.00 / $1,350.00	Professional	26	$1,350.00	$1,350.00	$1,350.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,149.00 / $3,149.00 / $3,149.00	Professional	TC	$3,149.00	$3,149.00	$3,149.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $409.89 / $641.66 / $1,459.65	Professional		$409.89	$641.66	$1,459.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.01 / $98.87 / $221.63	Professional	26	$71.01	$98.87	$221.63
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $333.91 / $543.29 / $1,318.63	Professional	TC	$333.91	$543.29	$1,318.63
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,680.35 / $1,680.35 / $1,680.35	Professional		$1,680.35	$1,680.35	$1,680.35
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $272.54 / $272.54 / $272.54	Professional	26	$272.54	$272.54	$272.54
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,407.81 / $1,407.81 / $1,407.81	Professional	TC	$1,407.81	$1,407.81	$1,407.81
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $233.84 / $402.51 / $653.16	Professional		$233.84	$402.51	$653.16
United Facility/Professional Professional Modifier Low / Median / High Price $341.61 / $635.17 / $1,554.33	Professional		$341.61	$635.17	$1,554.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.29 / $106.47 / $279.52	Professional	26	$60.29	$106.47	$279.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $316.08 / $528.71 / $1,286.72	Professional	TC	$316.08	$528.71	$1,286.72