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 / $424.40	Facility	26	$140.00	$140.00	$424.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $302.06 / $522.50 / $1,706.28	Professional		$302.06	$522.50	$1,706.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.69 / $140.00 / $365.40	Professional	26	$78.69	$140.00	$365.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $119.41 / $237.50 / $771.22	Professional	52	$119.41	$237.50	$771.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $196.03 / $335.00 / $812.00	Professional	TC	$196.03	$335.00	$812.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.63 / $246.42 / $417.73	Professional		$144.63	$246.42	$417.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.17 / $74.80 / $156.02	Professional	26	$55.17	$74.80	$156.02
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.97 / $112.97 / $112.97	Professional	TC	$112.97	$112.97	$112.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $308.33 / $551.45 / $994.61	Professional		$308.33	$551.45	$994.61
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.12 / $86.25 / $171.03	Professional	26	$64.12	$86.25	$171.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $224.24 / $455.91 / $834.18	Professional	TC	$224.24	$455.91	$834.18
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $286.50 / $436.45 / $1,033.96	Professional		$286.50	$436.45	$1,033.96
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $89.16 / $214.00	Professional	26	$65.14	$89.16	$214.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $227.28 / $348.23 / $831.17	Professional	TC	$227.28	$348.23	$831.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $228.03 / $497.00 / $935.04	Professional		$228.03	$497.00	$935.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.10 / $84.49 / $192.17	Professional	26	$42.10	$84.49	$192.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $166.85 / $381.42 / $810.26	Professional	TC	$166.85	$381.42	$810.26
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $226.34 / $300.08 / $405.11	Professional		$226.34	$300.08	$405.11
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $76.72 / $103.57	Professional	26	$40.74	$76.72	$103.57
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $185.60 / $223.36 / $301.54	Professional	TC	$185.60	$223.36	$301.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $233.45 / $315.77 / $564.15	Professional		$233.45	$315.77	$564.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.05 / $99.74 / $400.00	Professional	26	$69.05	$99.74	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.42 / $271.66 / $525.00	Professional	TC	$190.42	$271.66	$525.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $632.64 / $632.64 / $650.32	Facility	26	$632.64	$632.64	$650.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,918.81 / $3,507.01 / $3,612.22	Professional		$2,918.81	$3,507.01	$3,612.22
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $571.29 / $571.29 / $571.29	Professional	26	$571.29	$571.29	$571.29
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,477.29 / $2,539.44 / $2,545.16	Professional	TC	$2,477.29	$2,539.44	$2,545.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $247.06	Professional		$32.34	$32.34	$247.06
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $241.29 / $520.03 / $821.89	Professional		$241.29	$520.03	$821.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.70 / $82.53 / $187.50	Professional	26	$41.70	$82.53	$187.50
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $281.11 / $281.11 / $284.64	Professional	52	$281.11	$281.11	$284.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $166.85 / $398.41 / $780.68	Professional	TC	$166.85	$398.41	$780.68
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $887.53 / $887.53 / $887.53	Professional		$887.53	$887.53	$887.53
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $238.27 / $238.27 / $238.27	Professional	26	$238.27	$238.27	$238.27
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $649.25 / $649.25 / $649.25	Professional	TC	$649.25	$649.25	$649.25
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $242.69 / $316.87 / $384.77	Professional		$242.69	$316.87	$384.77
United Facility/Professional Professional Modifier Low / Median / High Price $229.76 / $382.19 / $801.04	Professional		$229.76	$382.19	$801.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.70 / $79.05 / $183.24	Professional	26	$56.70	$79.05	$183.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.95 / $308.64 / $646.64	Professional	TC	$165.95	$308.64	$646.64