Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $140.00 / $175.00 / $636.39	Facility	26	$140.00	$175.00	$636.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $372.85 / $494.18 / $2,715.60	Professional		$372.85	$494.18	$2,715.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.35 / $161.00 / $561.00	Professional	26	$109.35	$161.00	$561.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $267.85 / $335.00 / $1,020.25	Professional	TC	$267.85	$335.00	$1,020.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $262.37 / $344.00 / $1,821.32	Professional		$262.37	$344.00	$1,821.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.38 / $171.41 / $280.18	Professional	26	$83.38	$171.41	$280.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $165.04 / $312.95 / $312.95	Professional	TC	$165.04	$312.95	$312.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $417.34 / $847.75 / $1,800.39	Professional		$417.34	$847.75	$1,800.39
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $99.12 / $131.02 / $260.77	Professional	26	$99.12	$131.02	$260.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $295.64 / $691.96 / $1,548.04	Professional	TC	$295.64	$691.96	$1,548.04
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $419.33 / $638.57 / $1,482.06	Professional		$419.33	$638.57	$1,482.06
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $136.25 / $331.04	Professional	26	$100.00	$136.25	$331.04
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $327.89 / $502.33 / $1,156.72	Professional	TC	$327.89	$502.33	$1,156.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $333.66 / $721.88 / $1,595.68	Professional		$333.66	$721.88	$1,595.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.94 / $129.82 / $296.37	Professional	26	$64.94	$129.82	$296.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $243.46 / $542.79 / $1,397.01	Professional	TC	$243.46	$542.79	$1,397.01
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $332.91 / $441.73 / $596.34	Professional		$332.91	$441.73	$596.34
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.91 / $115.41 / $155.80	Professional	26	$69.91	$115.41	$155.80
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $263.00 / $326.32 / $440.53	Professional	TC	$263.00	$326.32	$440.53
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $224.44 / $224.44 / $224.44	Professional	26	$224.44	$224.44	$224.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $344.00 / $458.66 / $831.80	Professional		$344.00	$458.66	$831.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $103.87 / $149.57 / $400.00	Professional	26	$103.87	$149.57	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $278.20 / $382.70 / $750.00	Professional	TC	$278.20	$382.70	$750.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $954.08 / $954.08 / $973.04	Facility	26	$954.08	$954.08	$973.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,025.38 / $6,206.15 / $6,206.15	Professional		$6,025.38	$6,206.15	$6,206.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $891.52 / $891.52 / $891.52	Professional	26	$891.52	$891.52	$891.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,457.89 / $5,621.63 / $5,621.63	Professional	TC	$5,457.89	$5,621.63	$5,621.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $355.26	Professional		$32.34	$32.34	$355.26
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $342.51 / $767.17 / $1,440.18	Professional		$342.51	$767.17	$1,440.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.30 / $127.05 / $282.16	Professional	26	$64.30	$127.05	$282.16
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $243.46 / $552.03 / $1,354.16	Professional	TC	$243.46	$552.03	$1,354.16
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,304.01 / $1,304.01 / $1,304.01	Professional		$1,304.01	$1,304.01	$1,304.01
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $356.62 / $356.62 / $356.62	Professional	26	$356.62	$356.62	$356.62
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $947.38 / $947.38 / $947.38	Professional	TC	$947.38	$947.38	$947.38
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $357.24 / $466.08 / $565.95	Professional		$357.24	$466.08	$565.95
United Facility/Professional Professional Modifier Low / Median / High Price $337.13 / $566.65 / $1,294.85	Professional		$337.13	$566.65	$1,294.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.39 / $113.40 / $265.10	Professional	26	$87.39	$113.40	$265.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $242.03 / $449.72 / $994.62	Professional	TC	$242.03	$449.72	$994.62