Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $140.00 / $144.66 / $665.28	Facility	26	$140.00	$144.66	$665.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.50 / $522.50 / $2,129.80	Professional		$370.50	$522.50	$2,129.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $118.59 / $175.00 / $567.02	Professional	26	$118.59	$175.00	$567.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.35 / $335.00 / $981.20	Professional	TC	$259.35	$335.00	$981.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.27 / $308.39 / $716.30	Professional		$199.27	$308.39	$716.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $88.43 / $155.85 / $534.36	Professional	26	$88.43	$155.85	$534.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $404.19 / $851.98 / $1,781.04	Professional		$404.19	$851.98	$1,781.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $114.10 / $159.80 / $319.92	Professional	26	$114.10	$159.80	$319.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $277.44 / $691.96 / $1,544.51	Professional	TC	$277.44	$691.96	$1,544.51
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $313.29 / $480.30 / $1,171.68	Professional		$313.29	$480.30	$1,171.68
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $137.94 / $334.46	Professional	26	$100.00	$137.94	$334.46
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $220.71 / $343.54 / $825.29	Professional	TC	$220.71	$343.54	$825.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.55 / $639.58 / $1,545.74	Professional		$302.55	$639.58	$1,545.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.98 / $139.07 / $306.04	Professional	26	$65.98	$139.07	$306.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $211.04 / $469.04 / $1,356.58	Professional	TC	$211.04	$469.04	$1,356.58
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $313.24 / $417.50 / $563.63	Professional		$313.24	$417.50	$563.63
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.84 / $120.56 / $162.76	Professional	26	$90.84	$120.56	$162.76
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $222.40 / $296.94 / $400.87	Professional	TC	$222.40	$296.94	$400.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $326.08 / $434.77 / $797.08	Professional		$326.08	$434.77	$797.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $108.50 / $156.24 / $400.00	Professional	26	$108.50	$156.24	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $253.17 / $348.27 / $682.96	Professional	TC	$253.17	$348.27	$682.96
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $996.56 / $996.56 / $1,016.96	Facility	26	$996.56	$996.56	$1,016.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,199.75 / $6,385.74 / $6,385.74	Professional		$6,199.75	$6,385.74	$6,385.74
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $931.20 / $931.20 / $931.20	Professional	26	$931.20	$931.20	$931.20
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,551.18 / $5,717.71 / $5,717.71	Professional	TC	$5,551.18	$5,717.71	$5,717.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $248.76	Professional		$32.34	$32.34	$248.76
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $318.02 / $699.35 / $1,408.62	Professional		$318.02	$699.35	$1,408.62
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $65.94 / $137.06 / $303.74	Professional	26	$65.94	$137.06	$303.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $211.04 / $488.87 / $1,355.66	Professional	TC	$211.04	$488.87	$1,355.66
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,225.51 / $1,225.51 / $1,225.51	Professional		$1,225.51	$1,225.51	$1,225.51
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $373.09 / $373.09 / $373.09	Professional	26	$373.09	$373.09	$373.09
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $852.41 / $852.41 / $852.41	Professional	TC	$852.41	$852.41	$852.41
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $337.63 / $464.24 / $2,368.34	Professional		$337.63	$464.24	$2,368.34
United Facility/Professional Professional Modifier Low / Median / High Price $317.50 / $555.59 / $1,238.09	Professional		$317.50	$555.59	$1,238.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.27 / $123.50 / $277.10	Professional	26	$99.27	$123.50	$277.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $217.80 / $376.30 / $968.03	Professional	TC	$217.80	$376.30	$968.03