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 / $502.53	Facility	26	$140.00	$140.00	$502.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $277.24 / $475.00 / $1,800.24	Professional		$277.24	$475.00	$1,800.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $140.00 / $357.29	Professional	26	$85.00	$140.00	$357.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.88 / $335.00 / $783.89	Professional	TC	$192.88	$335.00	$783.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $289.98 / $289.98 / $289.98	Professional		$289.98	$289.98	$289.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.52 / $61.52 / $61.52	Professional	26	$61.52	$61.52	$61.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $364.49 / $633.38 / $1,131.83	Professional		$364.49	$633.38	$1,131.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.40 / $107.48 / $218.48	Professional	26	$77.40	$107.48	$218.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $261.66 / $525.46 / $965.71	Professional	TC	$261.66	$525.46	$965.71
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $341.37 / $520.08 / $1,202.73	Professional		$341.37	$520.08	$1,202.73
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.18 / $104.63 / $253.93	Professional	26	$77.18	$104.63	$253.93
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $271.17 / $415.45 / $955.78	Professional	TC	$271.17	$415.45	$955.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $266.14 / $573.49 / $1,101.89	Professional		$266.14	$573.49	$1,101.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.05 / $100.43 / $228.43	Professional	26	$50.05	$100.43	$228.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $193.72 / $432.92 / $899.46	Professional	TC	$193.72	$432.92	$899.46
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $265.02 / $353.01 / $476.56	Professional		$265.02	$353.01	$476.56
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.01 / $90.49 / $122.16	Professional	26	$53.01	$90.49	$122.16
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $212.02 / $262.52 / $354.40	Professional	TC	$212.02	$262.52	$354.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $274.72 / $367.29 / $664.29	Professional		$274.72	$367.29	$664.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.44 / $117.64 / $400.00	Professional	26	$81.44	$117.64	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.84 / $307.92 / $572.29	Professional	TC	$223.84	$307.92	$572.29
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $746.48 / $746.48 / $764.32	Facility	26	$746.48	$746.48	$764.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,389.77 / $3,491.47 / $3,491.47	Professional		$3,389.77	$3,491.47	$3,491.47
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $657.14 / $657.14 / $657.14	Professional	26	$657.14	$657.14	$657.14
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,953.83 / $3,042.45 / $3,042.45	Professional	TC	$2,953.83	$3,042.45	$3,042.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $294.02	Professional		$32.34	$32.34	$294.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $271.55 / $600.85 / $966.97	Professional		$271.55	$600.85	$966.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.48 / $98.36 / $217.50	Professional	26	$49.48	$98.36	$217.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $193.72 / $445.69 / $886.00	Professional	TC	$193.72	$445.69	$886.00
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,035.89 / $1,035.89 / $1,035.89	Professional		$1,035.89	$1,035.89	$1,035.89
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $282.04 / $282.04 / $282.04	Professional	26	$282.04	$282.04	$282.04
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $753.84 / $753.84 / $753.84	Professional	TC	$753.84	$753.84	$753.84
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $285.50 / $392.56 / $1,370.98	Professional		$285.50	$392.56	$1,370.98
United Facility/Professional Professional Modifier Low / Median / High Price $268.11 / $454.48 / $1,063.08	Professional		$268.11	$454.48	$1,063.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.92 / $88.78 / $209.66	Professional	26	$66.92	$88.78	$209.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $192.64 / $356.47 / $723.94	Professional	TC	$192.64	$356.47	$723.94