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 / $621.65	Facility	26	$140.00	$140.00	$621.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $347.81 / $522.50 / $2,701.33	Professional		$347.81	$522.50	$2,701.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.00 / $176.40 / $548.00	Professional	26	$110.00	$176.40	$548.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.35 / $335.00 / $860.40	Professional	TC	$259.35	$335.00	$860.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.55 / $482.40 / $1,824.37	Professional		$213.55	$482.40	$1,824.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.41 / $125.05 / $186.77	Professional	26	$75.41	$125.05	$186.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $407.88 / $784.32 / $1,658.08	Professional		$407.88	$784.32	$1,658.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.29 / $126.95 / $251.67	Professional	26	$95.29	$126.95	$251.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $298.35 / $657.36 / $1,338.16	Professional	TC	$298.35	$657.36	$1,338.16
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $416.93 / $635.04 / $1,473.04	Professional		$416.93	$635.04	$1,473.04
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.57 / $129.53 / $314.54	Professional	26	$95.57	$129.53	$314.54
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $329.99 / $505.53 / $1,164.72	Professional	TC	$329.99	$505.53	$1,164.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $332.18 / $733.00 / $1,609.46	Professional		$332.18	$733.00	$1,609.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.10 / $120.47 / $284.62	Professional	26	$61.10	$120.47	$284.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $240.79 / $561.52 / $1,426.59	Professional	TC	$240.79	$561.52	$1,426.59
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $333.07 / $442.73 / $597.69	Professional		$333.07	$442.73	$597.69
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.61 / $113.19 / $152.81	Professional	26	$66.61	$113.19	$152.81
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $266.45 / $329.53 / $444.87	Professional	TC	$266.45	$329.53	$444.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $344.57 / $459.43 / $855.37	Professional		$344.57	$459.43	$855.37
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 $280.94 / $386.46 / $750.00	Professional	TC	$280.94	$386.46	$750.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $935.44 / $935.44 / $950.80	Facility	26	$935.44	$935.44	$950.80
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,978.92 / $6,158.29 / $6,158.29	Professional		$5,978.92	$6,158.29	$6,158.29
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $733.09 / $733.09 / $824.33	Professional	26	$733.09	$733.09	$824.33
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 / $357.85	Professional		$32.34	$32.34	$357.85
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $116.17 / $116.17 / $116.17	Facility	26	$116.17	$116.17	$116.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $336.12 / $774.30 / $1,464.42	Professional		$336.12	$774.30	$1,464.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $59.28 / $116.09 / $282.58	Professional	26	$59.28	$116.09	$282.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $237.48 / $587.66 / $1,404.18	Professional	TC	$237.48	$587.66	$1,404.18
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,303.06 / $1,303.06 / $1,303.06	Professional		$1,303.06	$1,303.06	$1,303.06
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $348.46 / $348.46 / $348.46	Professional	26	$348.46	$348.46	$348.46
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $954.59 / $954.59 / $954.59	Professional	TC	$954.59	$954.59	$954.59
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $358.04 / $492.31 / $952.18	Professional		$358.04	$492.31	$952.18
United Facility/Professional Professional Modifier Low / Median / High Price $336.82 / $564.98 / $1,271.79	Professional		$336.82	$564.98	$1,271.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.24 / $109.35 / $340.00	Professional	26	$83.24	$109.35	$340.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $243.87 / $457.68 / $1,011.12	Professional	TC	$243.87	$457.68	$1,011.12