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 / $349.90	Facility	26	$140.00	$140.00	$349.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $475.00 / $1,588.23	Professional		$250.00	$475.00	$1,588.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.12 / $140.00 / $322.00	Professional	26	$59.12	$140.00	$322.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $335.00 / $692.74	Professional	TC	$187.50	$335.00	$692.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $181.12 / $222.24 / $288.60	Professional		$181.12	$222.24	$288.60
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.22 / $85.52 / $128.25	Professional	26	$45.22	$85.52	$128.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $288.37 / $560.99 / $1,009.76	Professional		$288.37	$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 $219.09 / $482.56 / $867.88	Professional	TC	$219.09	$482.56	$867.88
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $275.95 / $420.79 / $996.05	Professional		$275.95	$420.79	$996.05
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.51 / $72.97 / $175.33	Professional	26	$53.51	$72.97	$175.33
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 $213.36 / $491.00 / $985.86	Professional		$213.36	$491.00	$985.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.60 / $69.56 / $159.19	Professional	26	$34.60	$69.56	$159.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $166.76 / $422.51 / $839.05	Professional	TC	$166.76	$422.51	$839.05
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $211.59 / $286.64 / $386.98	Professional		$211.59	$286.64	$386.98
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.62 / $63.15 / $85.25	Professional	26	$29.62	$63.15	$85.25
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $223.50 / $301.73	Professional	TC	$181.97	$223.50	$301.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $219.89 / $285.24 / $519.07	Professional		$219.89	$285.24	$519.07
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.82 / $75.78 / $145.25	Professional	26	$55.82	$75.78	$145.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $172.37 / $258.56 / $438.38	Professional	TC	$172.37	$258.56	$438.38
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $519.52 / $519.52 / $530.79	Facility	26	$519.52	$519.52	$530.79
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,882.90 / $2,961.02 / $2,976.23	Professional		$2,882.90	$2,961.02	$2,976.23
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 / $2,631.72 / $2,703.83	Professional	TC	$2,573.94	$2,631.72	$2,703.83
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 $64.84 / $64.84 / $64.84	Facility	26	$64.84	$64.84	$64.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $224.85 / $507.54 / $851.68	Professional		$224.85	$507.54	$851.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.10 / $67.98 / $154.38	Professional	26	$34.10	$67.98	$154.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $166.76 / $422.51 / $838.50	Professional	TC	$166.76	$422.51	$838.50
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $822.62 / $822.62 / $822.62	Professional		$822.62	$822.62	$822.62
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $196.21 / $196.21 / $196.21	Professional	26	$196.21	$196.21	$196.21
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $626.41 / $626.41 / $626.41	Professional	TC	$626.41	$626.41	$626.41
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $231.84 / $296.23 / $359.70	Professional		$231.84	$296.23	$359.70
United Facility/Professional Professional Modifier Low / Median / High Price $212.59 / $386.40 / $820.79	Professional		$212.59	$386.40	$820.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.46 / $61.71 / $145.27	Professional	26	$46.46	$61.71	$145.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $160.13 / $317.35 / $664.27	Professional	TC	$160.13	$317.35	$664.27