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 / $389.09	Facility	26	$140.00	$140.00	$389.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.38 / $475.00 / $1,513.96	Professional		$257.38	$475.00	$1,513.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.58 / $140.00 / $322.00	Professional	26	$67.58	$140.00	$322.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $335.00 / $931.29	Professional	TC	$187.50	$335.00	$931.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $205.91 / $205.91 / $217.44	Professional		$205.91	$205.91	$217.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.85 / $77.43 / $128.34	Professional	26	$47.85	$77.43	$128.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $307.26 / $538.11 / $1,008.36	Professional		$307.26	$538.11	$1,008.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $59.90 / $86.62 / $179.39	Professional	26	$59.90	$86.62	$179.39
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $217.61 / $451.58 / $827.54	Professional	TC	$217.61	$451.58	$827.54
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $281.58 / $429.17 / $1,014.79	Professional		$281.58	$429.17	$1,014.79
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.61 / $81.36 / $192.79	Professional	26	$59.61	$81.36	$192.79
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $227.28 / $348.23 / $831.17	Professional	TC	$227.28	$348.23	$831.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.95 / $72.95 / $72.95	Facility	26	$72.95	$72.95	$72.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $215.27 / $487.97 / $943.28	Professional		$215.27	$487.97	$943.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.34 / $75.26 / $179.51	Professional	26	$38.34	$75.26	$179.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $161.57 / $374.28 / $808.41	Professional	TC	$161.57	$374.28	$808.41
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $222.97 / $298.36 / $402.79	Professional		$222.97	$298.36	$402.79
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.82 / $70.41 / $95.05	Professional	26	$46.82	$70.41	$95.05
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $176.15 / $227.95 / $307.73	Professional	TC	$176.15	$227.95	$307.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $231.65 / $312.99 / $560.91	Professional		$231.65	$312.99	$560.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.37 / $91.53 / $400.00	Professional	26	$63.37	$91.53	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $194.33 / $276.60 / $525.00	Professional	TC	$194.33	$276.60	$525.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $580.79 / $580.79 / $596.96	Facility	26	$580.79	$580.79	$596.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,821.00 / $2,873.43 / $2,896.26	Professional		$2,821.00	$2,873.43	$2,896.26
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $625.77 / $625.77 / $625.77	Professional	26	$625.77	$625.77	$625.77
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,451.15 / $2,524.69 / $2,524.69	Professional	TC	$2,451.15	$2,524.69	$2,524.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $236.01	Professional		$32.34	$32.34	$236.01
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $72.95 / $72.95 / $72.95	Facility	26	$72.95	$72.95	$72.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $225.89 / $510.76 / $832.33	Professional		$225.89	$510.76	$832.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.90 / $72.83 / $177.39	Professional	26	$36.90	$72.83	$177.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $160.79 / $402.26 / $759.94	Professional	TC	$160.79	$402.26	$759.94
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $871.16 / $871.16 / $871.16	Professional		$871.16	$871.16	$871.16
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $218.30 / $218.30 / $218.30	Professional	26	$218.30	$218.30	$218.30
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $652.85 / $652.85 / $652.85	Professional	TC	$652.85	$652.85	$652.85
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $241.30 / $331.79 / $1,243.08	Professional		$241.30	$331.79	$1,243.08
United Facility/Professional Professional Modifier Low / Median / High Price $225.17 / $373.07 / $754.02	Professional		$225.17	$373.07	$754.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.27 / $69.20 / $161.49	Professional	26	$52.27	$69.20	$161.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $166.88 / $315.52 / $631.40	Professional	TC	$166.88	$315.52	$631.40