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 / $517.27	Facility	26	$140.00	$140.00	$517.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $284.18 / $475.00 / $1,799.81	Professional		$284.18	$475.00	$1,799.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.34 / $140.00 / $470.00	Professional	26	$88.34	$140.00	$470.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $195.26 / $335.00 / $931.29	Professional	TC	$195.26	$335.00	$931.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.54 / $62.54 / $62.54	Professional	26	$62.54	$62.54	$62.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $338.27 / $658.63 / $1,223.51	Professional		$338.27	$658.63	$1,223.51
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.84 / $114.22 / $225.38	Professional	26	$79.84	$114.22	$225.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $239.21 / $543.54 / $983.75	Professional	TC	$239.21	$543.54	$983.75
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $265.33 / $407.37 / $987.91	Professional		$265.33	$407.37	$987.91
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 $192.95 / $300.33 / $717.14	Professional	TC	$192.95	$300.33	$717.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.82 / $96.82 / $96.82	Facility	26	$96.82	$96.82	$96.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $256.55 / $534.96 / $1,018.45	Professional		$256.55	$534.96	$1,018.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.58 / $104.49 / $236.82	Professional	26	$51.58	$104.49	$236.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $185.29 / $410.31 / $844.96	Professional	TC	$185.29	$410.31	$844.96
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $265.52 / $354.60 / $478.71	Professional		$265.52	$354.60	$478.71
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.04 / $93.92 / $126.79	Professional	26	$69.04	$93.92	$126.79
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $196.49 / $260.68 / $351.92	Professional	TC	$196.49	$260.68	$351.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $276.29 / $369.43 / $675.38	Professional		$276.29	$369.43	$675.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.53 / $122.10 / $400.00	Professional	26	$84.53	$122.10	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $222.28 / $305.77 / $568.28	Professional	TC	$222.28	$305.77	$568.28
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $775.84 / $775.84 / $792.16	Facility	26	$775.84	$775.84	$792.16
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,447.72 / $3,551.15 / $3,551.15	Professional		$3,447.72	$3,551.15	$3,551.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $665.40 / $665.40 / $683.93	Professional	26	$665.40	$665.40	$683.93
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 / $217.72	Professional		$32.34	$32.34	$217.72
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.82 / $96.82 / $96.82	Facility	26	$96.82	$96.82	$96.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $269.51 / $582.26 / $916.92	Professional		$269.51	$582.26	$916.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.95 / $102.58 / $228.72	Professional	26	$50.95	$102.58	$228.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $183.89 / $414.97 / $811.13	Professional	TC	$183.89	$414.97	$811.13
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,035.63 / $1,035.63 / $1,035.63	Professional		$1,035.63	$1,035.63	$1,035.63
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $290.20 / $290.20 / $290.20	Professional	26	$290.20	$290.20	$290.20
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $745.42 / $745.42 / $745.42	Professional	TC	$745.42	$745.42	$745.42
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $286.77 / $394.31 / $1,663.66	Professional		$286.77	$394.31	$1,663.66
United Facility/Professional Professional Modifier Low / Median / High Price $268.11 / $427.55 / $915.44	Professional		$268.11	$427.55	$915.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.15 / $91.45 / $214.84	Professional	26	$69.15	$91.45	$214.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.49 / $337.73 / $726.15	Professional	TC	$190.49	$337.73	$726.15