Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $190.55 / $295.12	Facility	26	$141.25	$190.55	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $588.84 / $2,398.83	Professional		$338.84	$588.84	$2,398.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $204.17 / $537.03	Professional	26	$107.15	$204.17	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $354.81 / $1,445.44	Professional	TC	$245.47	$354.81	$1,445.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $426.58 / $758.58	Professional		$239.88	$426.58	$758.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $173.78 / $257.04	Professional	26	$89.13	$173.78	$257.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $1,071.52 / $1,778.28	Professional		$501.19	$1,071.52	$1,778.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $165.96 / $316.23	Professional	26	$114.82	$165.96	$316.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $891.25 / $1,548.82	Professional	TC	$371.54	$891.25	$1,548.82
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $645.65 / $1,202.26	Professional		$446.68	$645.65	$1,202.26
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $181.97 / $338.84	Professional	26	$131.83	$181.97	$338.84
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $457.09 / $851.14	Professional	TC	$316.23	$457.09	$851.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $123.03 / $177.83	Facility	26	$26.92	$123.03	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $645.65 / $1,479.11	Professional		$316.23	$645.65	$1,479.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $134.90 / $269.15	Professional	26	$77.62	$134.90	$269.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $467.74 / $1,258.93	Professional	TC	$213.80	$467.74	$1,258.93
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $416.87 / $562.34	Professional		$309.03	$416.87	$562.34
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $120.23 / $162.18	Professional	26	$91.20	$120.23	$162.18
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $302.00 / $407.38	Professional	TC	$223.87	$302.00	$407.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $416.87 / $776.25	Professional		$309.03	$416.87	$776.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $144.54 / $263.03	Professional	26	$107.15	$144.54	$263.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $338.84 / $575.44	Professional	TC	$251.19	$338.84	$575.44
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Facility	26	$1,000.00	$1,000.00	$1,000.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,309.57 / $6,309.57 / $6,309.57	Professional		$6,309.57	$6,309.57	$6,309.57
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $912.01 / $912.01 / $912.01	Professional	26	$912.01	$912.01	$912.01
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,754.40 / $5,754.40 / $5,754.40	Professional	TC	$5,754.40	$5,754.40	$5,754.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $128.82 / $380.19	Professional		$32.36	$128.82	$380.19
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $123.03 / $177.83	Facility	26	$26.92	$123.03	$177.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $660.69 / $1,412.54	Professional		$316.23	$660.69	$1,412.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $134.90 / $239.88	Professional	26	$67.61	$134.90	$239.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $467.74 / $1,318.26	Professional	TC	$208.93	$467.74	$1,318.26
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Professional		$1,230.27	$1,230.27	$1,230.27
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $371.54 / $371.54 / $371.54	Professional	26	$371.54	$371.54	$371.54
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $851.14 / $851.14 / $851.14	Professional	TC	$851.14	$851.14	$851.14
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $467.74 / $2,344.23	Professional		$346.74	$467.74	$2,344.23
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $512.86 / $1,174.90	Professional		$316.23	$512.86	$1,174.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $112.20 / $234.42	Professional	26	$87.10	$112.20	$234.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $363.08 / $954.99	Professional	TC	$218.78	$363.08	$954.99