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 $366.74 / $475.00 / $2,129.19	Professional		$366.74	$475.00	$2,129.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.20 / $140.00 / $420.00	Professional	26	$80.20	$140.00	$420.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.35 / $335.00 / $785.25	Professional	TC	$259.35	$335.00	$785.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $269.30 / $417.16 / $700.00	Professional		$269.30	$417.16	$700.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.11 / $63.16 / $144.04	Professional	26	$57.11	$63.16	$144.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.42 / $670.82 / $1,265.80	Professional		$380.42	$670.82	$1,265.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.25 / $94.91 / $191.06	Professional	26	$69.25	$94.91	$191.06
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $290.82 / $565.99 / $1,057.77	Professional	TC	$290.82	$565.99	$1,057.77
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $316.58 / $487.60 / $1,183.58	Professional		$316.58	$487.60	$1,183.58
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.28 / $98.47 / $238.20	Professional	26	$72.28	$98.47	$238.20
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $250.87 / $390.44 / $936.53	Professional	TC	$250.87	$390.44	$936.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.95 / $87.95 / $87.95	Facility	26	$87.95	$87.95	$87.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $289.49 / $570.13 / $1,108.80	Professional		$289.49	$570.13	$1,108.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.87 / $94.08 / $216.42	Professional	26	$46.87	$94.08	$216.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.89 / $460.33 / $924.62	Professional	TC	$234.89	$460.33	$924.62
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $313.01 / $415.55 / $560.99	Professional		$313.01	$415.55	$560.99
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.60 / $85.56 / $115.51	Professional	26	$62.60	$85.56	$115.51
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $250.41 / $329.99 / $445.49	Professional	TC	$250.41	$329.99	$445.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $321.58 / $419.42 / $750.00	Professional		$321.58	$419.42	$750.00
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 $281.33 / $387.00 / $650.00	Professional	TC	$281.33	$387.00	$650.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $703.76 / $703.76 / $720.40	Facility	26	$703.76	$703.76	$720.40
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 $597.70 / $597.70 / $616.42	Professional	26	$597.70	$597.70	$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 / $276.77	Professional		$32.34	$32.34	$276.77
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $87.95 / $87.95 / $87.95	Facility	26	$87.95	$87.95	$87.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $306.83 / $627.69 / $1,040.06	Professional		$306.83	$627.69	$1,040.06
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.60 / $92.11 / $210.36	Professional	26	$46.60	$92.11	$210.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $233.05 / $474.84 / $888.73	Professional	TC	$233.05	$474.84	$888.73
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,225.18 / $1,225.18 / $1,225.18	Professional		$1,225.18	$1,225.18	$1,225.18
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 $959.40 / $959.40 / $959.40	Professional	TC	$959.40	$959.40	$959.40
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $336.10 / $438.22 / $532.12	Professional		$336.10	$438.22	$532.12
United Facility/Professional Professional Modifier Low / Median / High Price $316.27 / $460.69 / $969.95	Professional		$316.27	$460.69	$969.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.33 / $83.73 / $197.58	Professional	26	$63.33	$83.73	$197.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.10 / $363.97 / $811.69	Professional	TC	$245.10	$363.97	$811.69