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 / $621.65	Facility	26	$140.00	$140.00	$621.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $388.58 / $475.00 / $2,502.26	Professional		$388.58	$475.00	$2,502.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.15 / $176.40 / $533.29	Professional	26	$111.15	$176.40	$533.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $266.93 / $335.00 / $931.29	Professional	TC	$266.93	$335.00	$931.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $283.89 / $451.13 / $761.87	Professional		$283.89	$451.13	$761.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.18 / $159.53 / $497.77	Professional	26	$75.18	$159.53	$497.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $418.43 / $840.27 / $1,784.77	Professional		$418.43	$840.27	$1,784.77
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.02 / $124.28 / $250.79	Professional	26	$94.02	$124.28	$250.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $299.52 / $691.96 / $1,540.84	Professional	TC	$299.52	$691.96	$1,540.84
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $407.97 / $622.39 / $1,460.61	Professional		$407.97	$622.39	$1,460.61
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.20 / $129.07 / $312.93	Professional	26	$95.20	$129.07	$312.93
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $321.33 / $492.26 / $1,141.95	Professional	TC	$321.33	$492.26	$1,141.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $328.97 / $700.49 / $1,585.01	Professional		$328.97	$700.49	$1,585.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.59 / $124.74 / $284.14	Professional	26	$61.59	$124.74	$284.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $236.16 / $524.03 / $1,346.73	Professional	TC	$236.16	$524.03	$1,346.73
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $333.68 / $445.48 / $601.40	Professional		$333.68	$445.48	$601.40
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.08 / $112.73 / $152.19	Professional	26	$80.08	$112.73	$152.19
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $253.60 / $332.75 / $449.21	Professional	TC	$253.60	$332.75	$449.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $346.65 / $462.20 / $847.37	Professional		$346.65	$462.20	$847.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.46 / $146.11 / $400.00	Professional	26	$101.46	$146.11	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $283.68 / $390.23 / $750.00	Professional	TC	$283.68	$390.23	$750.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $932.32 / $932.32 / $950.80	Facility	26	$932.32	$932.32	$950.80
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,981.06 / $6,160.49 / $6,160.49	Professional		$5,981.06	$6,160.49	$6,160.49
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $883.52 / $883.52 / $883.52	Professional	26	$883.52	$883.52	$883.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,438.76 / $5,601.93 / $5,601.93	Professional	TC	$5,438.76	$5,601.93	$5,601.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $348.46	Professional		$32.34	$32.34	$348.46
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $338.89 / $751.12 / $1,400.63	Professional		$338.89	$751.12	$1,400.63
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.86 / $120.98 / $274.52	Professional	26	$60.86	$120.98	$274.52
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $236.16 / $535.13 / $1,346.73	Professional	TC	$236.16	$535.13	$1,346.73
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,300.66 / $1,300.66 / $1,300.66	Professional		$1,300.66	$1,300.66	$1,300.66
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $348.46 / $348.46 / $348.46	Professional	26	$348.46	$348.46	$348.46
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $952.19 / $952.19 / $952.19	Professional	TC	$952.19	$952.19	$952.19
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $360.27 / $467.15 / $567.25	Professional		$360.27	$467.15	$567.25
United Facility/Professional Professional Modifier Low / Median / High Price $336.21 / $558.90 / $1,242.55	Professional		$336.21	$558.90	$1,242.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.97 / $109.59 / $259.00	Professional	26	$82.97	$109.59	$259.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $243.26 / $452.01 / $1,014.20	Professional	TC	$243.26	$452.01	$1,014.20