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 / $424.40	Facility	26	$140.00	$140.00	$424.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $221.15 / $475.00 / $1,729.88	Professional		$221.15	$475.00	$1,729.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.31 / $143.00 / $382.00	Professional	26	$72.31	$143.00	$382.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $156.03 / $335.00 / $692.74	Professional	TC	$156.03	$335.00	$692.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $163.98 / $199.04 / $355.95	Professional		$163.98	$199.04	$355.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.91 / $77.95 / $155.18	Professional	26	$51.91	$77.95	$155.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $265.88 / $537.66 / $962.49	Professional		$265.88	$537.66	$962.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $65.23 / $93.60 / $194.50	Professional	26	$65.23	$93.60	$194.50
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $176.41 / $448.82 / $797.81	Professional	TC	$176.41	$448.82	$797.81
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $276.33 / $420.89 / $963.16	Professional		$276.33	$420.89	$963.16
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.76 / $88.24 / $212.72	Professional	26	$64.76	$88.24	$212.72
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $217.43 / $333.15 / $762.38	Professional	TC	$217.43	$333.15	$762.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.65 / $445.68 / $912.84	Professional		$192.65	$445.68	$912.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.00 / $84.23 / $193.26	Professional	26	$42.00	$84.23	$193.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $136.44 / $330.44 / $721.57	Professional	TC	$136.44	$330.44	$721.57
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $190.96 / $254.64 / $343.76	Professional		$190.96	$254.64	$343.76
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.10 / $76.26 / $102.95	Professional	26	$40.10	$76.26	$102.95
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $150.86 / $178.38 / $240.81	Professional	TC	$150.86	$178.38	$240.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $199.04 / $274.64 / $494.48	Professional		$199.04	$274.64	$494.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.63 / $99.14 / $400.00	Professional	26	$68.63	$99.14	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $152.10 / $216.97 / $476.27	Professional	TC	$152.10	$216.97	$476.27
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $629.60 / $629.60 / $647.12	Facility	26	$629.60	$629.60	$647.12
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,831.41 / $2,916.35 / $2,916.35	Professional		$2,831.41	$2,916.35	$2,916.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $579.54 / $579.54 / $579.54	Professional	26	$579.54	$579.54	$579.54
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,465.48 / $2,539.44 / $2,539.44	Professional	TC	$2,465.48	$2,539.44	$2,539.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $235.39	Professional		$32.34	$32.34	$235.39
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $203.60 / $471.08 / $769.00	Professional		$203.60	$471.08	$769.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.54 / $82.75 / $187.50	Professional	26	$41.54	$82.75	$187.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $140.34 / $351.71 / $681.52	Professional	TC	$140.34	$351.71	$681.52
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $749.83 / $749.83 / $749.83	Professional		$749.83	$749.83	$749.83
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $238.27 / $238.27 / $238.27	Professional	26	$238.27	$238.27	$238.27
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $511.56 / $511.56 / $511.56	Professional	TC	$511.56	$511.56	$511.56
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $205.93 / $283.14 / $1,370.98	Professional		$205.93	$283.14	$1,370.98
United Facility/Professional Professional Modifier Low / Median / High Price $194.49 / $344.30 / $754.77	Professional		$194.49	$344.30	$754.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.42 / $75.06 / $170.25	Professional	26	$56.42	$75.06	$170.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.68 / $242.81 / $546.66	Professional	TC	$130.68	$242.81	$546.66