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 / $434.65	Facility	26	$140.00	$140.00	$434.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $259.60 / $475.00 / $1,811.52	Professional		$259.60	$475.00	$1,811.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.94 / $140.00 / $332.32	Professional	26	$72.94	$140.00	$332.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $335.00 / $1,020.25	Professional	TC	$187.50	$335.00	$1,020.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $121.85 / $121.85 / $122.86	Professional	26	$121.85	$121.85	$122.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $327.45 / $634.16 / $1,118.70	Professional		$327.45	$634.16	$1,118.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.40 / $79.23 / $160.61	Professional	26	$57.40	$79.23	$160.61
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $241.45 / $556.91 / $924.91	Professional	TC	$241.45	$556.91	$924.91
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $343.74 / $524.59 / $1,205.56	Professional		$343.74	$524.59	$1,205.56
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.51 / $72.97 / $183.75	Professional	26	$53.51	$72.97	$183.75
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $295.06 / $452.02 / $1,034.40	Professional	TC	$295.06	$452.02	$1,034.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.40 / $81.40 / $81.40	Facility	26	$81.40	$81.40	$81.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $235.70 / $510.54 / $1,033.44	Professional		$235.70	$510.54	$1,033.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.17 / $73.28 / $175.83	Professional	26	$39.17	$73.28	$175.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.84 / $437.97 / $897.96	Professional	TC	$181.84	$437.97	$897.96
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $240.58 / $325.04 / $438.80	Professional		$240.58	$325.04	$438.80
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.68 / $78.58 / $106.08	Professional	26	$33.68	$78.58	$106.08
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $206.90 / $246.45 / $332.71	Professional	TC	$206.90	$246.45	$332.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $249.89 / $324.50 / $611.08	Professional		$249.89	$324.50	$611.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.56 / $94.30 / $180.73	Professional	26	$69.56	$94.30	$180.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.04 / $285.06 / $483.37	Professional	TC	$190.04	$285.06	$483.37
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $648.08 / $648.08 / $666.24	Facility	26	$648.08	$648.08	$666.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,882.90 / $3,076.60 / $3,076.60	Professional		$2,882.90	$3,076.60	$3,076.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $596.05 / $867.00 / $867.00	Professional	26	$596.05	$867.00	$867.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,573.94 / $2,747.24 / $2,790.07	Professional	TC	$2,573.94	$2,747.24	$2,790.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $305.64	Professional		$32.34	$32.34	$305.64
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $81.40 / $81.40 / $81.40	Facility	26	$81.40	$81.40	$81.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $252.86 / $550.35 / $904.33	Professional		$252.86	$550.35	$904.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.43 / $70.40 / $166.26	Professional	26	$37.43	$70.40	$166.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $181.84 / $437.97 / $841.64	Professional	TC	$181.84	$437.97	$841.64
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $917.38 / $917.38 / $917.38	Professional		$917.38	$917.38	$917.38
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $244.08 / $244.08 / $244.08	Professional	26	$244.08	$244.08	$244.08
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $673.29 / $673.29 / $673.29	Professional	TC	$673.29	$673.29	$673.29
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $262.87 / $336.82 / $408.99	Professional		$262.87	$336.82	$408.99
United Facility/Professional Professional Modifier Low / Median / High Price $237.43 / $419.00 / $839.94	Professional		$237.43	$419.00	$839.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.61 / $76.87 / $212.54	Professional	26	$46.61	$76.87	$212.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $172.09 / $325.37 / $709.68	Professional	TC	$172.09	$325.37	$709.68