Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $229.09 / $524.81	Facility	26	$141.25	$229.09	$524.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $501.19 / $1,819.70	Professional		$281.84	$501.19	$1,819.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $147.91 / $467.74	Professional	26	$85.11	$147.91	$467.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $338.84 / $891.25	Professional	TC	$194.98	$338.84	$891.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $74.13 / $190.55	Professional	26	$74.13	$74.13	$190.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $758.58 / $1,230.27	Professional		$446.68	$758.58	$1,230.27
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $125.89 / $245.47	Professional	26	$89.13	$125.89	$245.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $630.96 / $1,000.00	Professional	TC	$331.13	$630.96	$1,000.00
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $537.03 / $1,000.00	Professional		$380.19	$537.03	$1,000.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $141.25 / $263.03	Professional	26	$102.33	$141.25	$263.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $398.11 / $741.31	Professional	TC	$275.42	$398.11	$741.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $524.81 / $1,000.00	Professional		$263.03	$524.81	$1,000.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $107.15 / $208.93	Professional	26	$60.26	$107.15	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $398.11 / $812.83	Professional	TC	$186.21	$398.11	$812.83
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $354.81 / $478.63	Professional		$263.03	$354.81	$478.63
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $95.50 / $128.82	Professional	26	$69.18	$95.50	$128.82
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $263.03 / $354.81	Professional	TC	$194.98	$263.03	$354.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $354.81 / $691.83	Professional		$263.03	$354.81	$691.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $112.20 / $208.93	Professional	26	$85.11	$112.20	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $302.00 / $512.86	Professional	TC	$223.87	$302.00	$512.86
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,548.13 / $3,548.13 / $3,548.13	Professional		$3,548.13	$3,548.13	$3,548.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $660.69 / $691.83 / $691.83	Professional	26	$660.69	$691.83	$691.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,090.30 / $3,090.30 / $3,090.30	Professional	TC	$3,090.30	$3,090.30	$3,090.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $100.00 / $316.23	Professional		$32.36	$100.00	$316.23
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $549.54 / $912.01	Professional		$269.15	$549.54	$912.01
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $102.33 / $186.21	Professional	26	$51.29	$102.33	$186.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $398.11 / $812.83	Professional	TC	$181.97	$398.11	$812.83
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,047.13 / $1,047.13	Professional		$1,047.13	$1,047.13	$1,047.13
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	26	$288.40	$288.40	$288.40
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $741.31 / $741.31 / $741.31	Professional	TC	$741.31	$741.31	$741.31
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $398.11 / $1,659.59	Professional		$295.12	$398.11	$1,659.59
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $426.58 / $870.96	Professional		$269.15	$426.58	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $87.10 / $181.97	Professional	26	$66.07	$87.10	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $316.23 / $691.83	Professional	TC	$190.55	$316.23	$691.83