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 / $473.65	Facility	26	$140.00	$140.00	$473.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $345.88 / $475.00 / $2,122.76	Professional		$345.88	$475.00	$2,122.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.67 / $140.00 / $389.19	Professional	26	$81.67	$140.00	$389.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $264.20 / $335.00 / $713.08	Professional	TC	$264.20	$335.00	$713.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $197.59 / $414.93 / $452.49	Professional		$197.59	$414.93	$452.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.82 / $63.16 / $172.73	Professional	26	$56.82	$63.16	$172.73
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $165.74 / $165.74 / $165.74	Professional	TC	$165.74	$165.74	$165.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.03 / $670.08 / $1,265.80	Professional		$380.03	$670.08	$1,265.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.25 / $94.91 / $189.72	Professional	26	$69.25	$94.91	$189.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $290.02 / $565.98 / $1,055.10	Professional	TC	$290.02	$565.98	$1,055.10
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $313.60 / $482.94 / $1,173.97	Professional		$313.60	$482.94	$1,173.97
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.28 / $98.94 / $237.87	Professional	26	$72.28	$98.94	$237.87
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $247.88 / $385.81 / $927.60	Professional	TC	$247.88	$385.81	$927.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.30 / $88.30 / $88.30	Facility	26	$88.30	$88.30	$88.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $284.82 / $563.00 / $1,101.48	Professional		$284.82	$563.00	$1,101.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.79 / $94.08 / $216.05	Professional	26	$46.79	$94.08	$216.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.25 / $457.26 / $901.66	Professional	TC	$234.25	$457.26	$901.66
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $312.36 / $413.26 / $557.90	Professional		$312.36	$413.26	$557.90
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.47 / $85.56 / $115.51	Professional	26	$62.47	$85.56	$115.51
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $249.89 / $327.70 / $442.40	Professional	TC	$249.89	$327.70	$442.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $319.83 / $423.15 / $678.78	Professional		$319.83	$423.15	$678.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.00 / $111.23 / $400.00	Professional	26	$77.00	$111.23	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $279.38 / $384.32 / $650.00	Professional	TC	$279.38	$384.32	$650.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $703.76 / $703.76 / $723.52	Facility	26	$703.76	$703.76	$723.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,348.15 / $3,448.60 / $3,448.60	Professional		$3,348.15	$3,448.60	$3,448.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $586.14 / $586.14 / $616.42	Professional	26	$586.14	$586.14	$616.42
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,941.88 / $3,030.13 / $3,030.13	Professional	TC	$2,941.88	$3,030.13	$3,030.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $256.74	Professional		$32.34	$32.34	$256.74
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $88.30 / $88.30 / $88.30	Facility	26	$88.30	$88.30	$88.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $304.35 / $625.29 / $1,037.89	Professional		$304.35	$625.29	$1,037.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.28 / $91.91 / $210.36	Professional	26	$46.28	$91.91	$210.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $232.42 / $473.13 / $881.41	Professional	TC	$232.42	$473.13	$881.41
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,222.77 / $1,222.77 / $1,222.77	Professional		$1,222.77	$1,222.77	$1,222.77
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $265.77 / $265.77 / $265.77	Professional	26	$265.77	$265.77	$265.77
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $957.00 / $957.00 / $957.00	Professional	TC	$957.00	$957.00	$957.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $334.25 / $437.31 / $531.01	Professional		$334.25	$437.31	$531.01
United Facility/Professional Professional Modifier Low / Median / High Price $315.66 / $458.13 / $1,038.60	Professional		$315.66	$458.13	$1,038.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.78 / $83.73 / $197.58	Professional	26	$62.78	$83.73	$197.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $244.49 / $363.06 / $826.46	Professional	TC	$244.49	$363.06	$826.46