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 / $518.22	Facility	26	$140.00	$140.00	$518.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.50 / $475.00 / $2,231.02	Professional		$370.50	$475.00	$2,231.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.39 / $140.00 / $416.99	Professional	26	$88.39	$140.00	$416.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $262.50 / $335.00 / $838.38	Professional	TC	$262.50	$335.00	$838.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $211.64 / $752.84 / $752.84	Professional		$211.64	$752.84	$752.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.83 / $63.83 / $63.83	Professional	26	$63.83	$63.83	$63.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $384.26 / $700.00 / $1,275.69	Professional		$384.26	$700.00	$1,275.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.84 / $115.40 / $241.59	Professional	26	$80.84	$115.40	$241.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $306.14 / $580.74 / $1,005.53	Professional	TC	$306.14	$580.74	$1,005.53
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $329.43 / $506.92 / $1,233.55	Professional		$329.43	$506.92	$1,233.55
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $107.58 / $258.39	Professional	26	$79.45	$107.58	$258.39
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $257.14 / $400.21 / $961.87	Professional	TC	$257.14	$400.21	$961.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.95 / $96.95 / $96.95	Facility	26	$96.95	$96.95	$96.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $297.25 / $572.22 / $1,151.27	Professional		$297.25	$572.22	$1,151.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.75 / $105.55 / $237.78	Professional	26	$51.75	$105.55	$237.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $247.16 / $452.10 / $913.18	Professional	TC	$247.16	$452.10	$913.18
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $329.74 / $441.80 / $596.42	Professional		$329.74	$441.80	$596.42
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.25 / $93.77 / $126.59	Professional	26	$69.25	$93.77	$126.59
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $260.49 / $348.04 / $469.85	Professional	TC	$260.49	$348.04	$469.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $338.74 / $437.44 / $801.00	Professional		$338.74	$437.44	$801.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.09 / $112.52 / $215.67	Professional	26	$83.09	$112.52	$215.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $268.36 / $400.25 / $652.72	Professional	TC	$268.36	$400.25	$652.72
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $774.40 / $774.40 / $793.04	Facility	26	$774.40	$774.40	$793.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,032.66 / $3,043.62 / $3,048.68	Professional		$3,032.66	$3,043.62	$3,048.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $854.80 / $854.80 / $854.80	Professional	26	$854.80	$854.80	$854.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,562.41 / $2,573.94 / $2,632.62	Professional	TC	$2,562.41	$2,573.94	$2,632.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $266.33	Professional		$32.34	$32.34	$266.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.95 / $96.95 / $96.95	Facility	26	$96.95	$96.95	$96.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $312.33 / $642.05 / $1,082.98	Professional		$312.33	$642.05	$1,082.98
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.52 / $103.20 / $230.27	Professional	26	$51.52	$103.20	$230.27
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $245.29 / $451.16 / $879.67	Professional	TC	$245.29	$451.16	$879.67
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,283.77 / $1,283.77 / $1,283.77	Professional		$1,283.77	$1,283.77	$1,283.77
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $291.26 / $291.26 / $291.26	Professional	26	$291.26	$291.26	$291.26
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $992.51 / $992.51 / $992.51	Professional	TC	$992.51	$992.51	$992.51
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $357.32 / $461.64 / $560.55	Professional		$357.32	$461.64	$560.55
United Facility/Professional Professional Modifier Low / Median / High Price $331.61 / $449.61 / $1,015.77	Professional		$331.61	$449.61	$1,015.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.52 / $92.16 / $225.89	Professional	26	$70.52	$92.16	$225.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $253.69 / $374.44 / $819.86	Professional	TC	$253.69	$374.44	$819.86