Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $140.00 / $140.00 / $428.28	Facility	26	$140.00	$140.00	$428.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $276.56 / $475.00 / $1,765.76	Professional		$276.56	$475.00	$1,765.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.88 / $140.00 / $418.11	Professional	26	$72.88	$140.00	$418.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $203.53 / $335.00 / $931.29	Professional	TC	$203.53	$335.00	$931.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $197.53 / $269.02 / $269.02	Professional		$197.53	$269.02	$269.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.43 / $108.63 / $166.20	Professional	26	$52.43	$108.63	$166.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $321.18 / $543.05 / $1,050.98	Professional		$321.18	$543.05	$1,050.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $65.22 / $90.30 / $182.79	Professional	26	$65.22	$90.30	$182.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $242.21 / $459.12 / $870.87	Professional	TC	$242.21	$459.12	$870.87
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $265.86 / $409.09 / $992.06	Professional		$265.86	$409.09	$992.06
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.37 / $89.06 / $214.69	Professional	26	$65.37	$89.06	$214.69
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $206.38 / $321.23 / $769.76	Professional	TC	$206.38	$321.23	$769.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.91 / $79.91 / $79.91	Facility	26	$79.91	$79.91	$79.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $241.56 / $481.44 / $935.71	Professional		$241.56	$481.44	$935.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.38 / $85.73 / $194.97	Professional	26	$42.38	$85.73	$194.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $193.05 / $377.38 / $751.26	Professional	TC	$193.05	$377.38	$751.26
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $346.82 / $381.50 / $468.21	Professional		$346.82	$381.50	$468.21
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.95 / $84.66 / $103.90	Professional	26	$76.95	$84.66	$103.90
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $269.86 / $296.85 / $364.31	Professional	TC	$269.86	$296.85	$364.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.02 / $358.69 / $657.60	Professional		$269.02	$358.69	$657.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.26 / $100.05 / $400.00	Professional	26	$69.26	$100.05	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $230.10 / $316.52 / $550.00	Professional	TC	$230.10	$316.52	$550.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $635.84 / $635.84 / $653.60	Facility	26	$635.84	$635.84	$653.60
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,872.81 / $2,958.99 / $2,958.99	Professional		$2,872.81	$2,958.99	$2,958.99
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $548.98 / $548.98 / $557.63	Professional	26	$548.98	$548.98	$557.63
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,498.98 / $2,573.94 / $2,573.94	Professional	TC	$2,498.98	$2,573.94	$2,573.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $213.72	Professional		$32.34	$32.34	$213.72
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.91 / $79.91 / $79.91	Facility	26	$79.91	$79.91	$79.91
Providence Facility/Professional Professional Modifier Low / Median / High Price $262.36 / $530.08 / $873.74	Professional		$262.36	$530.08	$873.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.90 / $85.14 / $189.05	Professional	26	$41.90	$85.14	$189.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $193.05 / $391.08 / $734.88	Professional	TC	$193.05	$391.08	$734.88
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,030.48 / $1,030.48 / $1,030.48	Professional		$1,030.48	$1,030.48	$1,030.48
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $240.58 / $240.58 / $240.58	Professional	26	$240.58	$240.58	$240.58
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $789.90 / $789.90 / $789.90	Professional	TC	$789.90	$789.90	$789.90
United Facility/Professional Professional Modifier Low / Median / High Price $266.27 / $393.58 / $842.90	Professional		$266.27	$393.58	$842.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.97 / $75.79 / $234.74	Professional	26	$56.97	$75.79	$234.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $201.85 / $299.74 / $669.82	Professional	TC	$201.85	$299.74	$669.82