Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $123.03 / $676.08	Facility	26	$93.33	$123.03	$676.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $537.03 / $1,445.44	Professional		$389.05	$537.03	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $154.88 / $467.74	Professional	26	$93.33	$154.88	$467.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $363.08 / $1,148.15	Professional	TC	$288.40	$363.08	$1,148.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Professional		$1,000.00	$1,000.00	$1,000.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $173.78 / $245.47	Professional	26	$89.13	$173.78	$245.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $707.95 / $1,412.54	Professional		$512.86	$707.95	$1,412.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $158.49 / $309.03	Professional	26	$109.65	$158.49	$309.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $549.54 / $1,096.48	Professional	TC	$398.11	$549.54	$1,096.48
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $630.96 / $1,380.38	Professional		$426.58	$630.96	$1,380.38
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $141.25 / $316.23	Professional	26	$100.00	$141.25	$316.23
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $478.63 / $1,071.52	Professional	TC	$331.13	$478.63	$1,071.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $562.34 / $1,174.90	Professional		$389.05	$562.34	$1,174.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $131.83 / $275.42	Professional	26	$91.20	$131.83	$275.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $446.68 / $933.25	Professional	TC	$309.03	$446.68	$933.25
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $537.03 / $724.44	Professional		$389.05	$537.03	$724.44
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $123.03 / $165.96	Professional	26	$81.28	$123.03	$165.96
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $416.87 / $562.34	Professional	TC	$309.03	$416.87	$562.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $537.03 / $977.24	Professional		$398.11	$537.03	$977.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $144.54 / $251.19	Professional	26	$107.15	$144.54	$251.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $478.63 / $794.33	Professional	TC	$323.59	$478.63	$794.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $660.69 / $660.69 / $660.69	Facility	26	$660.69	$660.69	$660.69
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,691.53 / $3,388.44 / $3,388.44	Professional		$2,691.53	$3,388.44	$3,388.44
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $660.69 / $851.14 / $851.14	Professional	26	$660.69	$851.14	$851.14
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,995.26 / $2,511.89 / $2,511.89	Professional	TC	$1,995.26	$2,511.89	$2,511.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $123.03 / $467.74	Professional		$32.36	$123.03	$467.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $575.44 / $1,174.90	Professional		$389.05	$575.44	$1,174.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $131.83 / $269.15	Professional	26	$91.20	$131.83	$269.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $446.68 / $933.25	Professional	TC	$309.03	$446.68	$933.25
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $1,513.56 / $1,513.56	Professional		$1,513.56	$1,513.56	$1,513.56
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $346.74 / $346.74 / $346.74	Professional	26	$346.74	$346.74	$346.74
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Professional	TC	$1,174.90	$1,174.90	$1,174.90
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $501.19 / $660.69	Professional		$389.05	$501.19	$660.69
United Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $575.44 / $1,174.90	Professional		$346.74	$575.44	$1,174.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $138.04 / $263.03	Professional	26	$83.18	$138.04	$263.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $436.52 / $912.01	Professional	TC	$263.03	$436.52	$912.01