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 / $517.27	Facility	26	$140.00	$140.00	$517.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $299.02 / $475.00 / $1,789.34	Professional		$299.02	$475.00	$1,789.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.97 / $140.00 / $446.45	Professional	26	$87.97	$140.00	$446.45
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $138.85 / $237.50 / $894.67	Professional	52	$138.85	$237.50	$894.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $208.82 / $335.00 / $783.89	Professional	TC	$208.82	$335.00	$783.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $276.93 / $276.93 / $276.93	Professional		$276.93	$276.93	$276.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.20 / $154.28 / $391.00	Professional	26	$67.20	$154.28	$391.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $132.58 / $132.58 / $180.59	Professional	TC	$132.58	$132.58	$180.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $341.45 / $658.63 / $1,223.51	Professional		$341.45	$658.63	$1,223.51
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.84 / $114.22 / $226.40	Professional	26	$79.84	$114.22	$226.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $242.39 / $543.17 / $983.75	Professional	TC	$242.39	$543.17	$983.75
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $264.26 / $405.65 / $988.57	Professional		$264.26	$405.65	$988.57
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.05 / $107.15 / $261.32	Professional	26	$79.05	$107.15	$261.32
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $192.35 / $299.39 / $717.79	Professional	TC	$192.35	$299.39	$717.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $256.36 / $536.24 / $1,021.49	Professional		$256.36	$536.24	$1,021.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.50 / $103.67 / $236.82	Professional	26	$51.50	$103.67	$236.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $185.29 / $407.81 / $846.09	Professional	TC	$185.29	$407.81	$846.09
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $264.23 / $355.69 / $480.18	Professional		$264.23	$355.69	$480.18
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.34 / $93.63 / $126.40	Professional	26	$71.34	$93.63	$126.40
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $192.89 / $262.06 / $353.78	Professional	TC	$192.89	$262.06	$353.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $276.93 / $371.03 / $676.94	Professional		$276.93	$371.03	$676.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.27 / $121.72 / $400.00	Professional	26	$84.27	$121.72	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.45 / $307.38 / $571.29	Professional	TC	$223.45	$307.38	$571.29
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $771.20 / $771.20 / $789.76	Facility	26	$771.20	$771.20	$789.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,445.62 / $3,548.99 / $3,548.99	Professional		$3,445.62	$3,548.99	$3,548.99
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $672.00 / $672.00 / $675.90	Professional	26	$672.00	$672.00	$675.90
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,996.90 / $3,086.80 / $3,086.80	Professional	TC	$2,996.90	$3,086.80	$3,086.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $217.94	Professional		$32.34	$32.34	$217.94
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $268.32 / $581.16 / $916.34	Professional		$268.32	$581.16	$916.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.95 / $102.58 / $228.72	Professional	26	$50.95	$102.58	$228.72
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $328.35 / $328.35 / $328.35	Professional	52	$328.35	$328.35	$328.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $183.89 / $419.68 / $811.13	Professional	TC	$183.89	$419.68	$811.13
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,029.61 / $1,029.61 / $1,029.61	Professional		$1,029.61	$1,029.61	$1,029.61
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $290.20 / $290.20 / $290.20	Professional	26	$290.20	$290.20	$290.20
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $739.41 / $739.41 / $739.41	Professional	TC	$739.41	$739.41	$739.41
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $287.66 / $395.54 / $1,499.90	Professional		$287.66	$395.54	$1,499.90
United Facility/Professional Professional Modifier Low / Median / High Price $266.58 / $428.65 / $910.22	Professional		$266.58	$428.65	$910.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.14 / $91.31 / $216.74	Professional	26	$69.14	$91.31	$216.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $188.96 / $351.18 / $744.70	Professional	TC	$188.96	$351.18	$744.70