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 / $424.40	Facility	26	$140.00	$140.00	$424.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $350.48 / $475.00 / $1,760.66	Professional		$350.48	$475.00	$1,760.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.01 / $140.00 / $384.00	Professional	26	$78.01	$140.00	$384.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.35 / $335.00 / $692.74	Professional	TC	$259.35	$335.00	$692.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $322.16 / $322.16 / $349.59	Professional		$322.16	$322.16	$349.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.05 / $56.84 / $56.84	Professional	26	$51.05	$56.84	$56.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $360.93 / $586.51 / $1,163.57	Professional		$360.93	$586.51	$1,163.57
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.02 / $98.40 / $194.39	Professional	26	$69.02	$98.40	$194.39
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $285.00 / $494.30 / $969.18	Professional	TC	$285.00	$494.30	$969.18
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $286.20 / $440.81 / $1,097.39	Professional		$286.20	$440.81	$1,097.39
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.76 / $88.24 / $212.72	Professional	26	$64.76	$88.24	$212.72
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $227.28 / $353.75 / $880.87	Professional	TC	$227.28	$353.75	$880.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $303.30 / $559.76 / $1,183.20	Professional		$303.30	$559.76	$1,183.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.00 / $84.65 / $193.19	Professional	26	$42.00	$84.65	$193.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $262.50 / $470.98 / $985.63	Professional	TC	$262.50	$470.98	$985.63
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $338.60 / $419.10 / $565.79	Professional		$338.60	$419.10	$565.79
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.56 / $76.72 / $103.57	Professional	26	$57.56	$76.72	$103.57
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.04 / $342.38 / $462.21	Professional	TC	$281.04	$342.38	$462.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $336.01 / $448.01 / $776.00	Professional		$336.01	$448.01	$776.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.05 / $99.74 / $400.00	Professional	26	$69.05	$99.74	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $300.00 / $436.12 / $697.87	Professional	TC	$300.00	$436.12	$697.87
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $632.64 / $632.64 / $647.12	Facility	26	$632.64	$632.64	$647.12
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,916.35 / $3,077.22 / $3,113.67	Professional		$2,916.35	$3,077.22	$3,113.67
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $680.25 / $680.25 / $680.25	Professional	26	$680.25	$680.25	$680.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,539.44 / $2,677.57 / $2,677.57	Professional	TC	$2,539.44	$2,677.57	$2,677.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $262.02	Professional		$32.34	$32.34	$262.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $318.70 / $636.08 / $1,086.65	Professional		$318.70	$636.08	$1,086.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.30 / $82.17 / $187.50	Professional	26	$41.30	$82.17	$187.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $262.50 / $470.76 / $953.97	Professional	TC	$262.50	$470.76	$953.97
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,328.72 / $1,328.72 / $1,328.72	Professional		$1,328.72	$1,328.72	$1,328.72
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $238.27 / $238.27 / $238.27	Professional	26	$238.27	$238.27	$238.27
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,090.44 / $1,090.44 / $1,090.44	Professional	TC	$1,090.44	$1,090.44	$1,090.44
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $338.98 / $466.09 / $1,403.96	Professional		$338.98	$466.09	$1,403.96
United Facility/Professional Professional Modifier Low / Median / High Price $342.35 / $449.89 / $1,350.53	Professional		$342.35	$449.89	$1,350.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.42 / $75.06 / $176.59	Professional	26	$56.42	$75.06	$176.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $278.54 / $397.60 / $869.93	Professional	TC	$278.54	$397.60	$869.93