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 / $1,349.96	Professional		$250.00	$475.00	$1,349.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.04 / $140.00 / $322.00	Professional	26	$60.04	$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 26 Low / Median / High Price $44.98 / $44.98 / $44.98	Professional	26	$44.98	$44.98	$44.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $322.75 / $607.23 / $1,107.11	Professional		$322.75	$607.23	$1,107.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.71 / $74.41 / $149.80	Professional	26	$53.71	$74.41	$149.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $259.52 / $536.67 / $889.66	Professional	TC	$259.52	$536.67	$889.66
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $321.94 / $491.22 / $1,125.54	Professional		$321.94	$491.22	$1,125.54
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.14 / $72.48 / $174.44	Professional	26	$53.14	$72.48	$174.44
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $273.56 / $419.10 / $959.07	Professional	TC	$273.56	$419.10	$959.07
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 $220.01 / $499.39 / $970.18	Professional		$220.01	$499.39	$970.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.46 / $69.37 / $159.94	Professional	26	$34.46	$69.37	$159.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.76 / $415.59 / $841.84	Professional	TC	$177.76	$415.59	$841.84
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $222.78 / $302.72 / $408.67	Professional		$222.78	$302.72	$408.67
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.19 / $62.69 / $84.63	Professional	26	$31.19	$62.69	$84.63
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $191.59 / $240.03 / $324.04	Professional	TC	$191.59	$240.03	$324.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $231.94 / $300.70 / $569.11	Professional		$231.94	$300.70	$569.11
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 $185.10 / $277.64 / $470.76	Professional	TC	$185.10	$277.64	$470.76
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 $2,882.90 / $2,955.62 / $2,972.47	Professional		$2,882.90	$2,955.62	$2,972.47
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $596.05 / $596.05 / $596.05	Professional	26	$596.05	$596.05	$596.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,573.94 / $2,626.86 / $2,698.84	Professional	TC	$2,573.94	$2,626.86	$2,698.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $283.35	Professional		$32.34	$32.34	$283.35
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 $236.01 / $518.60 / $849.34	Professional		$236.01	$518.60	$849.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.10 / $68.39 / $158.76	Professional	26	$34.10	$68.39	$158.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $177.76 / $416.87 / $839.05	Professional	TC	$177.76	$416.87	$839.05
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $856.28 / $856.28 / $856.28	Professional		$856.28	$856.28	$856.28
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 $661.27 / $661.27 / $661.27	Professional	TC	$661.27	$661.27	$661.27
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $244.83 / $311.89 / $378.73	Professional		$244.83	$311.89	$378.73
United Facility/Professional Professional Modifier Low / Median / High Price $221.18 / $406.42 / $827.83	Professional		$221.18	$406.42	$827.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.46 / $61.35 / $144.35	Professional	26	$46.46	$61.35	$144.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.03 / $308.01 / $674.01	Professional	TC	$169.03	$308.01	$674.01