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 / $502.53	Facility	26	$140.00	$140.00	$502.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $318.58 / $475.00 / $1,989.34	Professional		$318.58	$475.00	$1,989.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.04 / $140.00 / $327.58	Professional	26	$84.04	$140.00	$327.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $228.90 / $335.00 / $770.50	Professional	TC	$228.90	$335.00	$770.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $123.04 / $123.04 / $123.04	Professional	26	$123.04	$123.04	$123.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $372.48 / $677.54 / $1,285.50	Professional		$372.48	$677.54	$1,285.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.89 / $102.10 / $202.42	Professional	26	$75.89	$102.10	$202.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $285.00 / $566.48 / $1,032.45	Professional	TC	$285.00	$566.48	$1,032.45
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $376.91 / $574.50 / $1,335.36	Professional		$376.91	$574.50	$1,335.36
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $76.81 / $104.18 / $252.72	Professional	26	$76.81	$104.18	$252.72
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $307.00 / $470.32 / $1,088.63	Professional	TC	$307.00	$470.32	$1,088.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.75 / $606.36 / $1,141.03	Professional		$301.75	$606.36	$1,141.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.72 / $100.43 / $228.43	Professional	26	$49.72	$100.43	$228.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $229.56 / $494.85 / $971.69	Professional	TC	$229.56	$494.85	$971.69
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $299.22 / $399.83 / $539.77	Professional		$299.22	$399.83	$539.77
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.86 / $90.49 / $122.16	Professional	26	$53.86	$90.49	$122.16
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $245.36 / $309.33 / $417.61	Professional	TC	$245.36	$309.33	$417.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $310.17 / $411.26 / $724.66	Professional		$310.17	$411.26	$724.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.44 / $117.64 / $400.00	Professional	26	$81.44	$117.64	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $263.73 / $362.80 / $650.00	Professional	TC	$263.73	$362.80	$650.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $746.48 / $746.48 / $764.32	Facility	26	$746.48	$746.48	$764.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,392.38 / $3,491.47 / $3,491.47	Professional		$3,392.38	$3,491.47	$3,491.47
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $667.05 / $667.05 / $667.05	Professional	26	$667.05	$667.05	$667.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,981.99 / $3,042.45 / $3,063.70	Professional	TC	$2,981.99	$3,042.45	$3,063.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $318.02	Professional		$32.34	$32.34	$318.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $307.61 / $652.44 / $1,058.33	Professional		$307.61	$652.44	$1,058.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.24 / $97.85 / $217.50	Professional	26	$49.24	$97.85	$217.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $229.56 / $504.03 / $952.44	Professional	TC	$229.56	$504.03	$952.44
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,175.33 / $1,175.33 / $1,175.33	Professional		$1,175.33	$1,175.33	$1,175.33
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $282.04 / $282.04 / $282.04	Professional	26	$282.04	$282.04	$282.04
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $893.29 / $893.29 / $893.29	Professional	TC	$893.29	$893.29	$893.29
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $323.38 / $418.91 / $508.68	Professional		$323.38	$418.91	$508.68
United Facility/Professional Professional Modifier Low / Median / High Price $303.70 / $464.44 / $1,017.72	Professional		$303.70	$464.44	$1,017.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.92 / $88.78 / $210.66	Professional	26	$66.92	$88.78	$210.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $228.23 / $393.53 / $915.89	Professional	TC	$228.23	$393.53	$915.89