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 / $624.14	Facility	26	$140.00	$140.00	$624.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $398.87 / $522.50 / $2,559.56	Professional		$398.87	$522.50	$2,559.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.15 / $145.65 / $504.00	Professional	26	$111.15	$145.65	$504.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $298.83 / $350.52 / $1,461.00	Professional	TC	$298.83	$350.52	$1,461.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $322.02 / $369.08 / $693.88	Professional		$322.02	$369.08	$693.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.41 / $159.02 / $228.70	Professional	26	$75.41	$159.02	$228.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $468.00 / $852.63 / $1,814.74	Professional		$468.00	$852.63	$1,814.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.91 / $124.28 / $250.79	Professional	26	$92.91	$124.28	$250.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $350.56 / $709.55 / $1,613.26	Professional	TC	$350.56	$709.55	$1,613.26
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $388.56 / $597.91 / $1,453.51	Professional		$388.56	$597.91	$1,453.51
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.57 / $129.53 / $314.47	Professional	26	$95.57	$129.53	$314.47
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $301.62 / $469.43 / $1,127.53	Professional	TC	$301.62	$469.43	$1,127.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.87 / $116.87 / $116.87	Facility	26	$116.87	$116.87	$116.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $369.38 / $723.40 / $1,585.01	Professional		$369.38	$723.40	$1,585.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.84 / $124.74 / $285.66	Professional	26	$61.84	$124.74	$285.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $283.22 / $575.99 / $1,384.63	Professional	TC	$283.22	$575.99	$1,384.63
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $386.13 / $509.28 / $687.53	Professional		$386.13	$509.28	$687.53
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.95 / $113.19 / $152.81	Professional	26	$84.95	$113.19	$152.81
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $301.18 / $396.09 / $534.72	Professional	TC	$301.18	$396.09	$534.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $390.79 / $523.67 / $957.45	Professional		$390.79	$523.67	$957.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.87 / $146.68 / $400.00	Professional	26	$101.87	$146.68	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $300.00 / $464.48 / $863.48	Professional	TC	$300.00	$464.48	$863.48
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $935.44 / $935.44 / $957.12	Facility	26	$935.44	$935.44	$957.12
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,981.06 / $6,160.49 / $6,160.49	Professional		$5,981.06	$6,160.49	$6,160.49
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $883.52 / $894.00 / $894.00	Professional	26	$883.52	$894.00	$894.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,438.76 / $5,601.93 / $5,601.93	Professional	TC	$5,438.76	$5,601.93	$5,601.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $312.76	Professional		$32.34	$32.34	$312.76
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $116.87 / $116.87 / $116.87	Facility	26	$116.87	$116.87	$116.87
Providence Facility/Professional Professional Modifier Low / Median / High Price $387.35 / $817.80 / $1,430.95	Professional		$387.35	$817.80	$1,430.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.10 / $120.98 / $276.69	Professional	26	$61.10	$120.98	$276.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $281.05 / $609.83 / $1,349.77	Professional	TC	$281.05	$609.83	$1,349.77
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,512.23 / $1,512.23 / $1,512.23	Professional		$1,512.23	$1,512.23	$1,512.23
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $349.66 / $349.66 / $349.66	Professional	26	$349.66	$349.66	$349.66
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,162.57 / $1,162.57 / $1,162.57	Professional	TC	$1,162.57	$1,162.57	$1,162.57
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $411.89 / $540.58 / $656.41	Professional		$411.89	$540.58	$656.41
United Facility/Professional Professional Modifier Low / Median / High Price $390.20 / $579.44 / $1,343.20	Professional		$390.20	$579.44	$1,343.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.03 / $109.71 / $259.95	Professional	26	$77.03	$109.71	$259.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $296.95 / $455.74 / $1,080.83	Professional	TC	$296.95	$455.74	$1,080.83