Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $140.00 / $169.68 / $430.77	Facility	26	$140.00	$169.68	$430.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.03 / $508.65 / $1,395.58	Professional		$216.03	$508.65	$1,395.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.18 / $140.00 / $388.00	Professional	26	$73.18	$140.00	$388.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $99.20 / $237.50 / $707.83	Professional	52	$99.20	$237.50	$707.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $135.74 / $335.00 / $783.89	Professional	TC	$135.74	$335.00	$783.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $152.41 / $194.43 / $427.07	Professional		$152.41	$194.43	$427.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.80 / $69.65 / $157.36	Professional	26	$51.80	$69.65	$157.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $86.30 / $146.94 / $258.87	Professional	TC	$86.30	$146.94	$258.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $249.17 / $543.76 / $989.37	Professional		$249.17	$543.76	$989.37
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.39 / $95.25 / $187.28	Professional	26	$66.39	$95.25	$187.28
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.83 / $444.05 / $828.57	Professional	TC	$162.83	$444.05	$828.57
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $183.75 / $281.27 / $684.21	Professional		$183.75	$281.27	$684.21
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.84 / $90.29 / $217.20	Professional	26	$65.84	$90.29	$217.20
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $123.80 / $192.67 / $459.67	Professional	TC	$123.80	$192.67	$459.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $180.26 / $392.48 / $873.94	Professional		$180.26	$392.48	$873.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.82 / $86.21 / $197.21	Professional	26	$42.82	$86.21	$197.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.88 / $294.89 / $722.13	Professional	TC	$120.88	$294.89	$722.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $186.00 / $248.45 / $335.41	Professional		$186.00	$248.45	$335.41
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.52 / $77.88 / $105.14	Professional	26	$59.52	$77.88	$105.14
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $126.48 / $170.58 / $230.28	Professional	TC	$126.48	$170.58	$230.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.43 / $268.26 / $486.35	Professional		$194.43	$268.26	$486.35
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 $145.44 / $207.49 / $455.45	Professional	TC	$145.44	$207.49	$455.45
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $641.91 / $641.91 / $659.84	Facility	26	$641.91	$641.91	$659.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,145.84 / $3,240.21 / $3,240.21	Professional		$3,145.84	$3,240.21	$3,240.21
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $577.89 / $577.89 / $577.89	Professional	26	$577.89	$577.89	$577.89
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 / $141.80	Professional		$32.34	$32.34	$141.80
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $188.82 / $432.00 / $765.18	Professional		$188.82	$432.00	$765.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.30 / $84.97 / $191.22	Professional	26	$42.30	$84.97	$191.22
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $232.32 / $232.32 / $232.32	Professional	52	$232.32	$232.32	$232.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $120.26 / $306.30 / $705.61	Professional	TC	$120.26	$306.30	$705.61
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $723.29 / $723.29 / $723.29	Professional		$723.29	$723.29	$723.29
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 $481.50 / $481.50 / $481.50	Professional	TC	$481.50	$481.50	$481.50
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $200.93 / $276.27 / $1,403.96	Professional		$200.93	$276.27	$1,403.96
United Facility/Professional Professional Modifier Low / Median / High Price $187.74 / $326.68 / $728.04	Professional		$187.74	$326.68	$728.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.53 / $76.70 / $188.27	Professional	26	$57.53	$76.70	$188.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.01 / $228.57 / $583.05	Professional	TC	$123.01	$228.57	$583.05