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 $386.40 / $494.18 / $2,582.08	Professional		$386.40	$494.18	$2,582.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.10 / $150.40 / $528.64	Professional	26	$108.10	$150.40	$528.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $299.00 / $348.53 / $948.12	Professional	TC	$299.00	$348.53	$948.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $321.20 / $437.70 / $511.71	Professional		$321.20	$437.70	$511.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.22 / $125.05 / $230.44	Professional	26	$84.22	$125.05	$230.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $470.59 / $853.12 / $1,814.00	Professional		$470.59	$853.12	$1,814.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.35 / $124.72 / $251.67	Professional	26	$94.35	$124.72	$251.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $361.06 / $708.09 / $1,612.53	Professional	TC	$361.06	$708.09	$1,612.53
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $390.06 / $600.24 / $1,460.20	Professional		$390.06	$600.24	$1,460.20
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 $303.12 / $471.75 / $1,134.25	Professional	TC	$303.12	$471.75	$1,134.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.52 / $116.52 / $116.52	Facility	26	$116.52	$116.52	$116.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $367.79 / $721.93 / $1,585.01	Professional		$367.79	$721.93	$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 $281.95 / $574.25 / $1,384.03	Professional	TC	$281.95	$574.25	$1,384.03
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $384.87 / $507.90 / $685.67	Professional		$384.87	$507.90	$685.67
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.67 / $113.19 / $152.81	Professional	26	$84.67	$113.19	$152.81
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $300.20 / $394.71 / $532.86	Professional	TC	$300.20	$394.71	$532.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $382.49 / $520.47 / $900.00	Professional		$382.49	$520.47	$900.00
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 / $462.86 / $860.47	Professional	TC	$300.00	$462.86	$860.47
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $935.44 / $935.44 / $953.92	Facility	26	$935.44	$935.44	$953.92
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 / $883.52 / $883.52	Professional	26	$883.52	$883.52	$883.52
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 / $333.84	Professional		$32.34	$32.34	$333.84
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $116.52 / $116.52 / $116.52	Facility	26	$116.52	$116.52	$116.52
Providence Facility/Professional Professional Modifier Low / Median / High Price $386.76 / $819.30 / $1,437.78	Professional		$386.76	$819.30	$1,437.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.10 / $120.98 / $275.61	Professional	26	$61.10	$120.98	$275.61
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $280.47 / $611.01 / $1,349.18	Professional	TC	$280.47	$611.01	$1,349.18
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,509.83 / $1,509.83 / $1,509.83	Professional		$1,509.83	$1,509.83	$1,509.83
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 $1,160.16 / $1,160.16 / $1,160.16	Professional	TC	$1,160.16	$1,160.16	$1,160.16
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $410.78 / $538.80 / $654.27	Professional		$410.78	$538.80	$654.27
United Facility/Professional Professional Modifier Low / Median / High Price $389.59 / $578.53 / $1,392.83	Professional		$389.59	$578.53	$1,392.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.24 / $109.80 / $269.27	Professional	26	$83.24	$109.80	$269.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $296.33 / $454.37 / $1,060.40	Professional	TC	$296.33	$454.37	$1,060.40