Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.02 / $99.30 / $629.22	Facility	26	$94.02	$99.30	$629.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $393.25 / $466.64 / $1,159.95	Professional		$393.25	$466.64	$1,159.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.71 / $114.55 / $452.00	Professional	26	$90.71	$114.55	$452.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $302.52 / $327.68 / $898.55	Professional	TC	$302.52	$327.68	$898.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $846.79 / $846.79 / $846.79	Professional		$846.79	$846.79	$846.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $133.13 / $178.49 / $233.06	Professional	26	$133.13	$178.49	$233.06
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $482.23 / $640.57 / $1,288.90	Professional		$482.23	$640.57	$1,288.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $107.59 / $138.75 / $279.19	Professional	26	$107.59	$138.75	$279.19
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $376.26 / $501.82 / $1,009.71	Professional	TC	$376.26	$501.82	$1,009.71
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $326.35 / $486.14 / $1,172.01	Professional		$326.35	$486.14	$1,172.01
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $91.23 / $106.59 / $263.91	Professional	26	$91.23	$106.59	$263.91
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $252.81 / $379.55 / $907.92	Professional	TC	$252.81	$379.55	$907.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $390.15 / $571.91 / $1,381.72	Professional		$390.15	$571.91	$1,381.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.68 / $131.43 / $302.80	Professional	26	$89.68	$131.43	$302.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $312.32 / $451.54 / $1,099.08	Professional	TC	$312.32	$451.54	$1,099.08
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $387.69 / $529.90 / $715.37	Professional		$387.69	$529.90	$715.37
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.41 / $121.88 / $164.54	Professional	26	$81.41	$121.88	$164.54
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $306.27 / $408.02 / $550.83	Professional	TC	$306.27	$408.02	$550.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $405.33 / $529.90 / $938.00	Professional		$405.33	$529.90	$938.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.62 / $150.58 / $251.37	Professional	26	$104.62	$150.58	$251.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $314.49 / $478.47 / $767.08	Professional	TC	$314.49	$478.47	$767.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $246.31 / $529.44 / $529.44	Facility	26	$246.31	$529.44	$529.44
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,670.75 / $2,670.75 / $3,379.95	Professional		$2,670.75	$2,670.75	$3,379.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $657.16 / $657.16 / $856.05	Professional	26	$657.16	$657.16	$856.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,013.59 / $2,013.59 / $2,523.98	Professional	TC	$2,013.59	$2,013.59	$2,523.98
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 $390.15 / $583.52 / $1,319.68	Professional		$390.15	$583.52	$1,319.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $92.03 / $132.63 / $288.07	Professional	26	$92.03	$132.63	$288.07
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $325.38 / $462.70 / $1,042.48	Professional	TC	$325.38	$462.70	$1,042.48
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,518.44 / $1,518.44 / $1,518.44	Professional		$1,518.44	$1,518.44	$1,518.44
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $349.21 / $349.21 / $349.21	Professional	26	$349.21	$349.21	$349.21
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,169.22 / $1,169.22 / $1,169.22	Professional	TC	$1,169.22	$1,169.22	$1,169.22
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $428.61 / $542.77 / $659.08	Professional		$428.61	$542.77	$659.08
United Facility/Professional Professional Modifier Low / Median / High Price $343.03 / $576.08 / $1,450.65	Professional		$343.03	$576.08	$1,450.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.42 / $136.69 / $308.29	Professional	26	$82.42	$136.69	$308.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $260.61 / $439.39 / $1,087.02	Professional	TC	$260.61	$439.39	$1,087.02