Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.50 / $85.16 / $459.16	Facility	26	$71.50	$85.16	$459.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $433.43 / $551.65 / $2,562.00	Professional		$433.43	$551.65	$2,562.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.62 / $80.59 / $319.61	Professional	26	$67.62	$80.59	$319.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $348.60 / $416.19 / $941.36	Professional	TC	$348.60	$416.19	$941.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $375.67 / $430.43 / $756.86	Professional		$375.67	$430.43	$756.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.94 / $97.75 / $169.40	Professional	26	$66.94	$97.75	$169.40
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $359.68 / $359.68 / $367.59	Professional	TC	$359.68	$359.68	$367.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $468.93 / $592.48 / $1,219.38	Professional		$468.93	$592.48	$1,219.38
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $82.30 / $100.45 / $210.26	Professional	26	$82.30	$100.45	$210.26
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $390.30 / $488.14 / $1,009.12	Professional	TC	$390.30	$488.14	$1,009.12
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $388.61 / $600.03 / $1,275.90	Professional		$388.61	$600.03	$1,275.90
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.48 / $91.88 / $186.28	Professional	26	$74.48	$91.88	$186.28
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $327.94 / $510.71 / $1,088.80	Professional	TC	$327.94	$510.71	$1,088.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $410.76 / $599.72 / $1,408.41	Professional		$410.76	$599.72	$1,408.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.69 / $96.97 / $219.65	Professional	26	$66.69	$96.97	$219.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $354.71 / $519.13 / $1,216.69	Professional	TC	$354.71	$519.13	$1,216.69
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $348.12 / $559.04 / $754.72	Professional		$348.12	$559.04	$754.72
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.22 / $83.44 / $112.64	Professional	26	$52.22	$83.44	$112.64
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $295.89 / $475.61 / $642.07	Professional	TC	$295.89	$475.61	$642.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $417.55 / $552.45 / $1,001.57	Professional		$417.55	$552.45	$1,001.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.48 / $99.68 / $174.87	Professional	26	$68.48	$99.68	$174.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $365.07 / $546.95 / $894.15	Professional	TC	$365.07	$546.95	$894.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $178.45 / $337.57 / $367.41	Facility	26	$178.45	$337.57	$367.41
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,898.56 / $2,898.56 / $3,550.05	Professional		$2,898.56	$2,898.56	$3,550.05
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $479.37 / $479.37 / $597.08	Professional	26	$479.37	$479.37	$597.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,419.25 / $2,419.25 / $2,952.98	Professional	TC	$2,419.25	$2,419.25	$2,952.98
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 $407.40 / $581.24 / $1,407.85	Professional		$407.40	$581.24	$1,407.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $68.67 / $96.97 / $213.74	Professional	26	$68.67	$96.97	$213.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $359.51 / $526.85 / $1,216.69	Professional	TC	$359.51	$526.85	$1,216.69
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,598.58 / $1,598.58 / $1,598.58	Professional		$1,598.58	$1,598.58	$1,598.58
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $257.82 / $257.82 / $257.82	Professional	26	$257.82	$257.82	$257.82
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,340.76 / $1,340.76 / $1,340.76	Professional	TC	$1,340.76	$1,340.76	$1,340.76
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $452.18 / $508.70 / $621.74	Professional		$452.18	$508.70	$621.74
United Facility/Professional Professional Modifier Low / Median / High Price $411.98 / $554.25 / $1,387.67	Professional		$411.98	$554.25	$1,387.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.17 / $93.94 / $231.55	Professional	26	$68.17	$93.94	$231.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $343.26 / $457.70 / $1,246.46	Professional	TC	$343.26	$457.70	$1,246.46