Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.86 / $68.79 / $416.53	Facility	26	$66.86	$68.79	$416.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $424.10 / $500.13 / $2,053.00	Professional		$424.10	$500.13	$2,053.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.59 / $72.75 / $271.00	Professional	26	$63.59	$72.75	$271.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $345.85 / $433.28 / $1,204.51	Professional	TC	$345.85	$433.28	$1,204.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $267.79 / $267.79 / $267.79	Professional		$267.79	$267.79	$267.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $109.85 / $109.85 / $109.85	Professional	26	$109.85	$109.85	$109.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $486.42 / $800.47 / $1,628.91	Professional		$486.42	$800.47	$1,628.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.23 / $107.34 / $218.36	Professional	26	$72.23	$107.34	$218.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $412.28 / $693.13 / $1,410.55	Professional	TC	$412.28	$693.13	$1,410.55
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $381.73 / $588.41 / $1,459.28	Professional		$381.73	$588.41	$1,459.28
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $68.06 / $82.28 / $192.94	Professional	26	$68.06	$82.28	$192.94
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $328.79 / $509.76 / $1,264.20	Professional	TC	$328.79	$509.76	$1,264.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $270.02 / $557.97 / $1,477.88	Professional		$270.02	$557.97	$1,477.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.52 / $82.42 / $196.30	Professional	26	$37.52	$82.42	$196.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $232.50 / $508.86 / $1,279.28	Professional	TC	$232.50	$508.86	$1,279.28
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $432.46 / $566.12 / $764.26	Professional		$432.46	$566.12	$764.26
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.22 / $73.81 / $99.64	Professional	26	$56.22	$73.81	$99.64
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $376.24 / $492.31 / $664.62	Professional	TC	$376.24	$492.31	$664.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $410.95 / $555.99 / $1,063.63	Professional		$410.95	$555.99	$1,063.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.81 / $88.57 / $155.41	Professional	26	$60.81	$88.57	$155.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $377.77 / $545.60 / $925.54	Professional	TC	$377.77	$545.60	$925.54
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $160.18 / $301.25 / $326.42	Facility	26	$160.18	$301.25	$326.42
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,964.79 / $2,964.79 / $3,582.00	Professional		$2,964.79	$2,964.79	$3,582.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $426.62 / $426.62 / $532.35	Professional	26	$426.62	$426.62	$532.35
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,538.10 / $2,538.10 / $3,049.65	Professional	TC	$2,538.10	$2,538.10	$3,049.65
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 $322.33 / $532.53 / $1,446.01	Professional		$322.33	$532.53	$1,446.01
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.52 / $82.42 / $194.39	Professional	26	$37.52	$82.42	$194.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $232.50 / $508.72 / $1,279.28	Professional	TC	$232.50	$508.72	$1,279.28
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,677.84 / $1,677.84 / $1,677.84	Professional		$1,677.84	$1,677.84	$1,677.84
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $234.42 / $234.42	Professional	26	$234.42	$234.42	$234.42
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,443.41 / $1,443.41 / $1,443.41	Professional	TC	$1,443.41	$1,443.41	$1,443.41
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $457.91 / $605.45 / $735.19	Professional		$457.91	$605.45	$735.19
United Facility/Professional Professional Modifier Low / Median / High Price $399.87 / $517.54 / $1,457.48	Professional		$399.87	$517.54	$1,457.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.98 / $75.80 / $228.17	Professional	26	$57.98	$75.80	$228.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $341.89 / $442.19 / $1,359.68	Professional	TC	$341.89	$442.19	$1,359.68