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 / $430.77	Facility	26	$140.00	$140.00	$430.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $362.71 / $475.00 / $1,443.46	Professional		$362.71	$475.00	$1,443.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.43 / $140.00 / $409.25	Professional	26	$74.43	$140.00	$409.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $265.45 / $335.00 / $783.89	Professional	TC	$265.45	$335.00	$783.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $210.28 / $302.95 / $749.79	Professional		$210.28	$302.95	$749.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.57 / $68.45 / $156.62	Professional	26	$51.57	$68.45	$156.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $243.30 / $243.30 / $243.30	Professional	TC	$243.30	$243.30	$243.30
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $400.07 / $873.19 / $1,724.90	Professional		$400.07	$873.19	$1,724.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.73 / $114.50 / $215.67	Professional	26	$81.73	$114.50	$215.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $324.98 / $751.76 / $1,538.98	Professional	TC	$324.98	$751.76	$1,538.98
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $450.25 / $686.66 / $1,633.77	Professional		$450.25	$686.66	$1,633.77
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $80.02 / $108.44 / $252.25	Professional	26	$80.02	$108.44	$252.25
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $377.46 / $578.23 / $1,396.71	Professional	TC	$377.46	$578.23	$1,396.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $324.24 / $769.10 / $1,654.97	Professional		$324.24	$769.10	$1,654.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.68 / $98.44 / $204.44	Professional	26	$49.68	$98.44	$204.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $269.47 / $652.21 / $1,414.35	Professional	TC	$269.47	$652.21	$1,414.35
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $324.17 / $441.52 / $596.04	Professional		$324.17	$441.52	$596.04
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.38 / $77.42 / $104.52	Professional	26	$45.38	$77.42	$104.52
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $278.79 / $364.10 / $491.54	Professional	TC	$278.79	$364.10	$491.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $337.30 / $436.60 / $794.21	Professional		$337.30	$436.60	$794.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.55 / $92.90 / $178.07	Professional	26	$68.55	$92.90	$178.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $280.73 / $418.72 / $714.04	Professional	TC	$280.73	$418.72	$714.04
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $638.88 / $638.88 / $656.72	Facility	26	$638.88	$638.88	$656.72
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,311.18 / $5,470.52 / $5,470.52	Professional		$5,311.18	$5,470.52	$5,470.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $808.00 / $808.00 / $808.00	Professional	26	$808.00	$808.00	$808.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $4,858.99 / $5,004.77 / $5,004.77	Professional	TC	$4,858.99	$5,004.77	$5,004.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $391.69	Professional		$32.34	$32.34	$391.69
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $343.56 / $805.74 / $1,411.85	Professional		$343.56	$805.74	$1,411.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.84 / $96.74 / $199.11	Professional	26	$48.84	$96.74	$199.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $269.47 / $684.90 / $1,366.46	Professional	TC	$269.47	$684.90	$1,366.46
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,243.91 / $1,243.91 / $1,243.91	Professional		$1,243.91	$1,243.91	$1,243.91
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $241.78 / $241.78 / $241.78	Professional	26	$241.78	$241.78	$241.78
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,002.13 / $1,002.13 / $1,002.13	Professional	TC	$1,002.13	$1,002.13	$1,002.13
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $357.10 / $453.83 / $551.08	Professional		$357.10	$453.83	$551.08
United Facility/Professional Professional Modifier Low / Median / High Price $320.88 / $583.24 / $1,263.56	Professional		$320.88	$583.24	$1,263.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.73 / $78.25 / $179.72	Professional	26	$64.73	$78.25	$179.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $256.14 / $509.35 / $1,102.91	Professional	TC	$256.14	$509.35	$1,102.91