Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $72.44 / $316.23	Facility	26	$57.54	$72.44	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $467.74 / $1,445.44	Professional		$389.05	$467.74	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $72.44 / $263.03	Professional	26	$53.70	$72.44	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $398.11 / $1,000.00	Professional	TC	$331.13	$398.11	$1,000.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $912.01 / $912.01	Professional		$912.01	$912.01	$912.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $56.23 / $125.89	Professional	26	$56.23	$56.23	$125.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $371.54 / $371.54	Professional	TC	$371.54	$371.54	$371.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $537.03 / $1,174.90	Professional		$371.54	$537.03	$1,174.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $107.15 / $181.97	Professional	26	$60.26	$107.15	$181.97
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $436.52 / $1,000.00	Professional	TC	$275.42	$436.52	$1,000.00
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $524.81 / $1,023.29	Professional		$380.19	$524.81	$1,023.29
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $64.57 / $125.89	Professional	26	$48.98	$64.57	$125.89
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $457.09 / $891.25	Professional	TC	$331.13	$457.09	$891.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $630.96 / $1,174.90	Professional		$436.52	$630.96	$1,174.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $91.20 / $154.88	Professional	26	$61.66	$91.20	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $549.54 / $1,023.29	Professional	TC	$371.54	$549.54	$1,023.29
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $295.12 / $831.76	Professional		$194.98	$295.12	$831.76
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $69.18 / $91.20	Professional	26	$67.61	$69.18	$91.20
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $190.55 / $741.31	Professional	TC	$125.89	$190.55	$741.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $588.84 / $1,000.00	Professional		$478.63	$588.84	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $61.66 / $107.15	Professional	26	$54.95	$61.66	$107.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $549.54 / $912.01	Professional	TC	$457.09	$549.54	$912.01
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $416.87 / $416.87 / $416.87	Facility	26	$416.87	$416.87	$416.87
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,715.35 / $3,715.35 / $3,890.45	Professional		$3,715.35	$3,715.35	$3,890.45
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $616.60 / $616.60 / $616.60	Professional	26	$616.60	$616.60	$616.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,715.35 / $3,715.35 / $3,715.35	Professional	TC	$3,715.35	$3,715.35	$3,715.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $501.19 / $588.84	Professional		$81.28	$501.19	$588.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $676.08 / $1,148.15	Professional		$446.68	$676.08	$1,148.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $91.20 / $147.91	Professional	26	$61.66	$91.20	$147.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $537.03 / $1,023.29	Professional	TC	$371.54	$537.03	$1,023.29
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,380.38 / $1,380.38	Professional		$1,380.38	$1,380.38	$1,380.38
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $194.98 / $194.98	Professional	26	$194.98	$194.98	$194.98
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,202.26 / $1,202.26 / $1,202.26	Professional	TC	$1,202.26	$1,202.26	$1,202.26
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $478.63 / $645.65	Professional		$245.47	$478.63	$645.65
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $489.78 / $1,047.13	Professional		$338.84	$489.78	$1,047.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $77.62 / $151.36	Professional	26	$47.86	$77.62	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $407.38 / $870.96	Professional	TC	$281.84	$407.38	$870.96