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 / $394.02	Facility	26	$140.00	$140.00	$394.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $322.00 / $494.18 / $1,928.31	Professional		$322.00	$494.18	$1,928.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.06 / $140.00 / $368.00	Professional	26	$73.06	$140.00	$368.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $265.05 / $335.00 / $812.00	Professional	TC	$265.05	$335.00	$812.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $289.63 / $422.67 / $666.51	Professional		$289.63	$422.67	$666.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.37 / $60.51 / $143.97	Professional	26	$47.37	$60.51	$143.97
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $256.13 / $256.13 / $256.13	Professional	TC	$256.13	$256.13	$256.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $337.07 / $552.53 / $1,076.86	Professional		$337.07	$552.53	$1,076.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.89 / $78.95 / $156.52	Professional	26	$57.89	$78.95	$156.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $265.49 / $470.41 / $906.95	Professional	TC	$265.49	$470.41	$906.95
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $281.88 / $434.49 / $1,080.85	Professional		$281.88	$434.49	$1,080.85
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.98 / $81.84 / $196.59	Professional	26	$59.98	$81.84	$196.59
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $227.28 / $353.75 / $880.87	Professional	TC	$227.28	$353.75	$880.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $277.87 / $521.48 / $1,039.36	Professional		$277.87	$521.48	$1,039.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.70 / $77.98 / $178.53	Professional	26	$38.70	$77.98	$178.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $236.80 / $434.16 / $876.56	Professional	TC	$236.80	$434.16	$876.56
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $303.23 / $403.15 / $544.25	Professional		$303.23	$403.15	$544.25
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.58 / $71.31 / $96.28	Professional	26	$54.58	$71.31	$96.28
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $248.65 / $331.83 / $447.97	Professional	TC	$248.65	$331.83	$447.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $311.10 / $403.15 / $675.00	Professional		$311.10	$403.15	$675.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.19 / $92.72 / $400.00	Professional	26	$64.19	$92.72	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $282.89 / $389.16 / $650.66	Professional	TC	$282.89	$389.16	$650.66
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $586.88 / $586.88 / $603.28	Facility	26	$586.88	$586.88	$603.28
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,819.97 / $2,873.43 / $2,873.43	Professional		$2,819.97	$2,873.43	$2,873.43
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $469.00 / $469.00 / $514.35	Professional	26	$469.00	$469.00	$514.35
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,495.53 / $2,524.69 / $2,563.91	Professional	TC	$2,495.53	$2,524.69	$2,563.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $280.31	Professional		$32.34	$32.34	$280.31
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $292.07 / $591.90 / $966.88	Professional		$292.07	$591.90	$966.88
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.50 / $75.78 / $175.11	Professional	26	$38.50	$75.78	$175.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $236.80 / $434.16 / $852.48	Professional	TC	$236.80	$434.16	$852.48
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,182.51 / $1,182.51 / $1,182.51	Professional		$1,182.51	$1,182.51	$1,182.51
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $220.70 / $220.70 / $220.70	Professional	26	$220.70	$220.70	$220.70
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $961.81 / $961.81 / $961.81	Professional	TC	$961.81	$961.81	$961.81
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $326.08 / $424.52 / $515.49	Professional		$326.08	$424.52	$515.49
United Facility/Professional Professional Modifier Low / Median / High Price $304.61 / $420.33 / $994.24	Professional		$304.61	$420.33	$994.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.71 / $69.29 / $163.37	Professional	26	$51.71	$69.29	$163.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.71 / $350.37 / $762.75	Professional	TC	$245.71	$350.37	$762.75