Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.55 / $69.64 / $340.48	Facility	26	$51.55	$69.64	$340.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $302.81 / $378.86 / $1,115.00	Professional		$302.81	$378.86	$1,115.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.33 / $60.69 / $228.52	Professional	26	$51.33	$60.69	$228.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $234.69 / $301.11 / $611.95	Professional	TC	$234.69	$301.11	$611.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $323.77 / $357.09 / $442.17	Professional		$323.77	$357.09	$442.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.53 / $60.67 / $97.10	Professional	26	$48.53	$60.67	$97.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $304.44 / $304.44 / $304.44	Professional	TC	$304.44	$304.44	$304.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $187.71 / $315.95 / $618.96	Professional		$187.71	$315.95	$618.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.17 / $65.75 / $126.42	Professional	26	$50.17	$65.75	$126.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $109.30 / $238.22 / $519.32	Professional	TC	$109.30	$238.22	$519.32
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $170.35 / $249.60 / $626.63	Professional		$170.35	$249.60	$626.63
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.51 / $51.38 / $121.03	Professional	26	$37.51	$51.38	$121.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $135.74 / $194.00 / $503.51	Professional	TC	$135.74	$194.00	$503.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.48 / $453.72 / $1,126.58	Professional		$229.48	$453.72	$1,126.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.93 / $72.36 / $163.12	Professional	26	$55.93	$72.36	$163.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.50 / $386.70 / $963.25	Professional	TC	$169.50	$386.70	$963.25
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $75.58 / $95.86 / $701.01	Professional		$75.58	$95.86	$701.01
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.28 / $46.01 / $85.55	Professional	26	$36.28	$46.01	$85.55
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.29 / $49.85 / $615.47	Professional	TC	$39.29	$49.85	$615.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $385.83 / $488.02 / $801.00	Professional		$385.83	$488.02	$801.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.31 / $64.04 / $114.38	Professional	26	$52.31	$64.04	$114.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $351.44 / $455.90 / $797.83	Professional	TC	$351.44	$455.90	$797.83
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $128.97 / $251.32 / $276.20	Facility	26	$128.97	$251.32	$276.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,452.27 / $2,452.27 / $3,270.00	Professional		$2,452.27	$2,452.27	$3,270.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $354.09 / $354.09 / $447.83	Professional	26	$354.09	$354.09	$447.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,098.17 / $2,098.17 / $2,822.18	Professional	TC	$2,098.17	$2,098.17	$2,822.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $534.66	Professional		$32.34	$32.34	$534.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $256.45 / $556.61 / $1,018.90	Professional		$256.45	$556.61	$1,018.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.93 / $73.09 / $154.06	Professional	26	$55.93	$73.09	$154.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $169.50 / $385.41 / $845.66	Professional	TC	$169.50	$385.41	$845.66
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,228.34 / $1,228.34 / $1,228.34	Professional		$1,228.34	$1,228.34	$1,228.34
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $188.95 / $188.95 / $188.95	Professional	26	$188.95	$188.95	$188.95
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,039.39 / $1,039.39 / $1,039.39	Professional	TC	$1,039.39	$1,039.39	$1,039.39
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $95.86 / $184.30 / $577.54	Professional		$95.86	$184.30	$577.54
United Facility/Professional Professional Modifier Low / Median / High Price $232.60 / $360.81 / $1,067.07	Professional		$232.60	$360.81	$1,067.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.19 / $61.01 / $156.52	Professional	26	$45.19	$61.01	$156.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $174.71 / $303.70 / $810.82	Professional	TC	$174.71	$303.70	$810.82