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 / $519.71	Facility	26	$140.00	$140.00	$519.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $285.62 / $475.00 / $1,829.02	Professional		$285.62	$475.00	$1,829.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.71 / $140.00 / $506.45	Professional	26	$87.71	$140.00	$506.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $197.75 / $335.00 / $585.16	Professional	TC	$197.75	$335.00	$585.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.77 / $62.77 / $62.77	Professional	26	$62.77	$62.77	$62.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $341.97 / $666.72 / $1,238.52	Professional		$341.97	$666.72	$1,238.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.84 / $122.73 / $241.00	Professional	26	$84.84	$122.73	$241.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $243.81 / $544.96 / $989.18	Professional	TC	$243.81	$544.96	$989.18
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $268.63 / $412.49 / $1,000.23	Professional		$268.63	$412.49	$1,000.23
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.53 / $107.97 / $261.32	Professional	26	$79.53	$107.97	$261.32
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $196.22 / $305.44 / $729.46	Professional	TC	$196.22	$305.44	$729.46
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.16 / $97.16 / $97.16	Facility	26	$97.16	$97.16	$97.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $260.45 / $551.90 / $1,108.97	Professional		$260.45	$551.90	$1,108.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.50 / $105.70 / $238.75	Professional	26	$51.50	$105.70	$238.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $188.30 / $421.25 / $883.74	Professional	TC	$188.30	$421.25	$883.74
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $270.64 / $361.49 / $488.01	Professional		$270.64	$361.49	$488.01
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.37 / $94.38 / $127.41	Professional	26	$70.37	$94.38	$127.41
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $200.28 / $267.11 / $360.60	Professional	TC	$200.28	$267.11	$360.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $281.50 / $375.34 / $688.12	Professional		$281.50	$375.34	$688.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.94 / $122.69 / $400.00	Professional	26	$84.94	$122.69	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $227.75 / $313.31 / $582.29	Professional	TC	$227.75	$313.31	$582.29
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $778.96 / $778.96 / $795.36	Facility	26	$778.96	$778.96	$795.36
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,482.54 / $3,587.02 / $3,587.02	Professional		$3,482.54	$3,587.02	$3,587.02
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $642.27 / $642.27 / $686.78	Professional	26	$642.27	$642.27	$686.78
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 / $203.20	Professional		$32.34	$32.34	$203.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $97.16 / $97.16 / $97.16	Facility	26	$97.16	$97.16	$97.16
Providence Facility/Professional Professional Modifier Low / Median / High Price $270.41 / $603.37 / $938.82	Professional		$270.41	$603.37	$938.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.24 / $102.58 / $237.94	Professional	26	$49.24	$102.58	$237.94
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $169.41 / $435.29 / $825.45	Professional	TC	$169.41	$435.29	$825.45
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,052.46 / $1,052.46 / $1,052.46	Professional		$1,052.46	$1,052.46	$1,052.46
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $291.41 / $291.41 / $291.41	Professional	26	$291.41	$291.41	$291.41
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $761.05 / $761.05 / $761.05	Professional	TC	$761.05	$761.05	$761.05
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $292.33 / $401.96 / $1,665.43	Professional		$292.33	$401.96	$1,665.43
United Facility/Professional Professional Modifier Low / Median / High Price $272.41 / $433.63 / $969.51	Professional		$272.41	$433.63	$969.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.12 / $97.74 / $216.66	Professional	26	$74.12	$97.74	$216.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.49 / $335.63 / $733.66	Professional	TC	$194.49	$335.63	$733.66