Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $186.21 / $426.58	Facility	26	$141.25	$186.21	$426.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $524.81 / $1,819.70	Professional		$295.12	$524.81	$1,819.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $141.25 / $380.19	Professional	26	$72.44	$141.25	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $354.81 / $1,148.15	Professional	TC	$204.17	$354.81	$1,148.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $380.19	Professional		$234.42	$234.42	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $56.23 / $158.49	Professional	26	$56.23	$56.23	$158.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $616.60 / $1,047.13	Professional		$371.54	$616.60	$1,047.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $97.72 / $194.98	Professional	26	$67.61	$97.72	$194.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $524.81 / $870.96	Professional	TC	$275.42	$524.81	$870.96
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $549.54 / $1,000.00	Professional		$380.19	$549.54	$1,000.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $117.49 / $213.80	Professional	26	$85.11	$117.49	$213.80
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $426.58 / $794.33	Professional	TC	$295.12	$426.58	$794.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	26	$16.98	$79.43	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $478.63 / $891.25	Professional		$251.19	$478.63	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $89.13 / $169.82	Professional	26	$48.98	$89.13	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $371.54 / $724.44	Professional	TC	$199.53	$371.54	$724.44
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $380.19 / $467.74	Professional		$346.74	$380.19	$467.74
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $85.11 / $104.71	Professional	26	$75.86	$85.11	$104.71
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $269.15 / $363.08	Professional	TC	$269.15	$269.15	$363.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $346.74 / $676.08	Professional		$251.19	$346.74	$676.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $91.20 / $165.96	Professional	26	$69.18	$91.20	$165.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $309.03 / $524.81	Professional	TC	$229.09	$309.03	$524.81
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $630.96 / $630.96 / $630.96	Facility	26	$630.96	$630.96	$630.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,951.21 / $2,951.21 / $2,951.21	Professional		$2,951.21	$2,951.21	$2,951.21
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $549.54 / $562.34 / $562.34	Professional	26	$549.54	$562.34	$562.34
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,570.40 / $2,570.40 / $2,570.40	Professional	TC	$2,570.40	$2,570.40	$2,570.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $83.18 / $309.03	Professional		$32.36	$83.18	$309.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	26	$16.98	$79.43	$112.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $512.86 / $812.83	Professional		$251.19	$512.86	$812.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $85.11 / $158.49	Professional	26	$42.66	$85.11	$158.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $363.08 / $691.83	Professional	TC	$190.55	$363.08	$691.83
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $1,023.29	Professional		$1,023.29	$1,023.29	$1,023.29
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $239.88 / $239.88	Professional	26	$239.88	$239.88	$239.88
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $794.33 / $794.33 / $794.33	Professional	TC	$794.33	$794.33	$794.33
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $371.54 / $758.58	Professional		$269.15	$371.54	$758.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $151.36	Professional	26	$53.70	$70.79	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $288.40 / $616.60	Professional	TC	$204.17	$288.40	$616.60