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 / $430.77	Facility	26	$140.00	$140.00	$430.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $233.59 / $475.00 / $1,376.33	Professional		$233.59	$475.00	$1,376.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.52 / $143.00 / $409.45	Professional	26	$72.52	$143.00	$409.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.16 / $335.00 / $614.05	Professional	TC	$131.16	$335.00	$614.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.04 / $194.09 / $271.72	Professional		$97.04	$194.09	$271.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.45 / $90.38 / $173.10	Professional	26	$55.45	$90.38	$173.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $96.76 / $96.76 / $113.70	Professional	TC	$96.76	$96.76	$113.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $248.34 / $550.96 / $998.87	Professional		$248.34	$550.96	$998.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $71.56 / $102.68 / $201.38	Professional	26	$71.56	$102.68	$201.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.83 / $444.06 / $828.34	Professional	TC	$162.83	$444.06	$828.34
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $184.65 / $282.68 / $687.60	Professional		$184.65	$282.68	$687.60
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.84 / $90.29 / $215.96	Professional	26	$65.84	$90.29	$215.96
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $124.68 / $194.07 / $464.14	Professional	TC	$124.68	$194.07	$464.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $179.31 / $397.43 / $876.21	Professional		$179.31	$397.43	$876.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.84 / $89.85 / $197.21	Professional	26	$42.84	$89.85	$197.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.24 / $294.89 / $722.13	Professional	TC	$120.24	$294.89	$722.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $185.35 / $248.00 / $334.80	Professional		$185.35	$248.00	$334.80
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.46 / $77.88 / $105.14	Professional	26	$57.46	$77.88	$105.14
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $127.89 / $170.12 / $229.66	Professional	TC	$127.89	$170.12	$229.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.09 / $267.77 / $482.26	Professional		$194.09	$267.77	$482.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.09 / $101.24 / $400.00	Professional	26	$70.09	$101.24	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $145.06 / $206.93 / $454.22	Professional	TC	$145.06	$206.93	$454.22
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $641.91 / $641.91 / $656.72	Facility	26	$641.91	$641.91	$656.72
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,174.82 / $3,270.06 / $3,270.06	Professional		$3,174.82	$3,270.06	$3,270.06
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $609.25 / $609.25 / $609.25	Professional	26	$609.25	$609.25	$609.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,772.01 / $2,855.17 / $2,855.17	Professional	TC	$2,772.01	$2,855.17	$2,855.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $141.07	Professional		$32.34	$32.34	$141.07
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $188.17 / $430.56 / $772.04	Professional		$188.17	$430.56	$772.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $89.00 / $190.13	Professional	26	$42.70	$89.00	$190.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $120.24 / $309.27 / $705.61	Professional	TC	$120.24	$309.27	$705.61
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $722.08 / $722.08 / $722.08	Professional		$722.08	$722.08	$722.08
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $241.78 / $241.78 / $241.78	Professional	26	$241.78	$241.78	$241.78
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $480.30 / $480.30 / $480.30	Professional	TC	$480.30	$480.30	$480.30
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $200.55 / $275.76 / $1,403.96	Professional		$200.55	$275.76	$1,403.96
United Facility/Professional Professional Modifier Low / Median / High Price $187.43 / $336.24 / $729.46	Professional		$187.43	$336.24	$729.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.95 / $80.72 / $179.72	Professional	26	$61.95	$80.72	$179.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.70 / $223.04 / $537.23	Professional	TC	$122.70	$223.04	$537.23