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 / $523.65	Facility	26	$140.00	$140.00	$523.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $380.57 / $475.00 / $2,643.76	Professional		$380.57	$475.00	$2,643.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.89 / $140.00 / $461.00	Professional	26	$90.89	$140.00	$461.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $266.77 / $335.00 / $931.29	Professional	TC	$266.77	$335.00	$931.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $260.33 / $503.54 / $625.49	Professional		$260.33	$503.54	$625.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.78 / $87.48 / $137.34	Professional	26	$62.78	$87.48	$137.34
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $418.94 / $887.23 / $1,728.97	Professional		$418.94	$887.23	$1,728.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.99 / $116.20 / $233.43	Professional	26	$84.99	$116.20	$233.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $327.05 / $751.75 / $1,538.98	Professional	TC	$327.05	$751.75	$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 / $263.35	Professional	26	$80.02	$108.44	$263.35
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $377.46 / $578.23 / $1,402.81	Professional	TC	$377.46	$578.23	$1,402.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.25 / $97.25 / $97.25	Facility	26	$97.25	$97.25	$97.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $334.80 / $781.25 / $1,664.85	Professional		$334.80	$781.25	$1,664.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.81 / $104.46 / $239.17	Professional	26	$51.81	$104.46	$239.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $271.35 / $654.41 / $1,424.23	Professional	TC	$271.35	$654.41	$1,424.23
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $339.06 / $459.81 / $620.74	Professional		$339.06	$459.81	$620.74
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.47 / $94.33 / $127.35	Professional	26	$47.47	$94.33	$127.35
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $291.58 / $365.48 / $493.40	Professional	TC	$291.58	$365.48	$493.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $350.00 / $456.58 / $864.44	Professional		$350.00	$456.58	$864.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.47 / $113.20 / $216.96	Professional	26	$83.47	$113.20	$216.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $281.79 / $420.30 / $716.73	Professional	TC	$281.79	$420.30	$716.73
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $777.44 / $777.44 / $796.16	Facility	26	$777.44	$777.44	$796.16
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 $97.25 / $97.25 / $97.25	Facility	26	$97.25	$97.25	$97.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $359.46 / $832.14 / $1,424.20	Professional		$359.46	$832.14	$1,424.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $101.83 / $231.56	Professional	26	$51.23	$101.83	$231.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $271.35 / $689.63 / $1,373.14	Professional	TC	$271.35	$689.63	$1,373.14
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,303.06 / $1,303.06 / $1,303.06	Professional		$1,303.06	$1,303.06	$1,303.06
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $293.70 / $293.70 / $293.70	Professional	26	$293.70	$293.70	$293.70
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,009.34 / $1,009.34 / $1,009.34	Professional	TC	$1,009.34	$1,009.34	$1,009.34
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $371.89 / $474.69 / $576.41	Professional		$371.89	$474.69	$576.41
United Facility/Professional Professional Modifier Low / Median / High Price $336.52 / $600.08 / $1,291.83	Professional		$336.52	$600.08	$1,291.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.41 / $92.39 / $217.46	Professional	26	$69.41	$92.39	$217.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.98 / $555.04 / $1,191.58	Professional	TC	$257.98	$555.04	$1,191.58