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 / $347.46	Facility	26	$140.00	$140.00	$347.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $475.00 / $1,228.16	Professional		$250.00	$475.00	$1,228.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.55 / $140.00 / $338.90	Professional	26	$63.55	$140.00	$338.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.97 / $335.00 / $680.05	Professional	TC	$187.97	$335.00	$680.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $137.00 / $221.54 / $450.41	Professional		$137.00	$221.54	$450.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.53 / $76.01 / $126.85	Professional	26	$42.53	$76.01	$126.85
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $149.16 / $149.16 / $149.16	Professional	TC	$149.16	$149.16	$149.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $287.51 / $560.99 / $1,009.76	Professional		$287.51	$560.99	$1,009.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.98 / $77.70 / $152.13	Professional	26	$56.98	$77.70	$152.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $218.23 / $482.56 / $867.88	Professional	TC	$218.23	$482.56	$867.88
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $275.95 / $420.79 / $992.73	Professional		$275.95	$420.79	$992.73
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.51 / $73.02 / $175.72	Professional	26	$53.51	$73.02	$175.72
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 $64.84 / $64.84 / $64.84	Facility	26	$64.84	$64.84	$64.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $212.40 / $492.22 / $983.05	Professional		$212.40	$492.22	$983.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.60 / $69.79 / $159.07	Professional	26	$34.60	$69.79	$159.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $166.14 / $423.45 / $839.05	Professional	TC	$166.14	$423.45	$839.05
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $210.94 / $285.73 / $385.74	Professional		$210.94	$285.73	$385.74
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.53 / $62.69 / $84.63	Professional	26	$29.53	$62.69	$84.63
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $181.41 / $223.05 / $301.12	Professional	TC	$181.41	$223.05	$301.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $219.20 / $285.73 / $517.46	Professional		$219.20	$285.73	$517.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.47 / $75.23 / $144.19	Professional	26	$55.47	$75.23	$144.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $172.01 / $258.02 / $437.48	Professional	TC	$172.01	$258.02	$437.48
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $516.48 / $516.48 / $530.79	Facility	26	$516.48	$516.48	$530.79
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,885.07 / $2,968.23 / $2,983.73	Professional		$2,885.07	$2,968.23	$2,983.73
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $505.24 / $505.24 / $505.24	Professional	26	$505.24	$505.24	$505.24
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,573.94 / $2,638.88 / $2,710.11	Professional	TC	$2,573.94	$2,638.88	$2,710.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $247.06	Professional		$32.34	$32.34	$247.06
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $64.84 / $64.84 / $64.84	Facility	26	$64.84	$64.84	$64.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $505.29 / $853.05	Professional		$223.87	$505.29	$853.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.10 / $68.26 / $154.38	Professional	26	$34.10	$68.26	$154.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $166.14 / $423.45 / $836.83	Professional	TC	$166.14	$423.45	$836.83
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $819.01 / $819.01 / $819.01	Professional		$819.01	$819.01	$819.01
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $195.01 / $195.01 / $195.01	Professional	26	$195.01	$195.01	$195.01
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $624.00 / $624.00 / $624.00	Professional	TC	$624.00	$624.00	$624.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $231.10 / $295.32 / $358.60	Professional		$231.10	$295.32	$358.60
United Facility/Professional Professional Modifier Low / Median / High Price $211.67 / $382.01 / $789.40	Professional		$211.67	$382.01	$789.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.46 / $61.35 / $144.94	Professional	26	$46.46	$61.35	$144.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $159.52 / $310.55 / $674.10	Professional	TC	$159.52	$310.55	$674.10