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 / $636.39	Facility	26	$140.00	$140.00	$636.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $383.76 / $509.78 / $2,772.82	Professional		$383.76	$509.78	$2,772.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.39 / $176.40 / $547.00	Professional	26	$108.39	$176.40	$547.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.35 / $335.00 / $1,020.25	Professional	TC	$259.35	$335.00	$1,020.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $269.02 / $356.85 / $1,828.70	Professional		$269.02	$356.85	$1,828.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $76.94 / $163.18 / $256.48	Professional	26	$76.94	$163.18	$256.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $314.72 / $446.50 / $446.50	Professional	TC	$314.72	$446.50	$446.50
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $418.13 / $857.51 / $1,799.37	Professional		$418.13	$857.51	$1,799.37
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.79 / $130.84 / $259.91	Professional	26	$98.79	$130.84	$259.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $296.81 / $691.96 / $1,548.74	Professional	TC	$296.81	$691.96	$1,548.74
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $419.93 / $639.50 / $1,485.25	Professional		$419.93	$639.50	$1,485.25
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $136.25 / $331.04	Professional	26	$100.00	$136.25	$331.04
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $328.50 / $503.24 / $1,159.90	Professional	TC	$328.50	$503.24	$1,159.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $334.39 / $723.75 / $1,595.68	Professional		$334.39	$723.75	$1,595.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.94 / $129.82 / $296.37	Professional	26	$64.94	$129.82	$296.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $244.08 / $544.14 / $1,398.72	Professional	TC	$244.08	$544.14	$1,398.72
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $333.52 / $443.57 / $598.82	Professional		$333.52	$443.57	$598.82
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.04 / $115.41 / $155.80	Professional	26	$70.04	$115.41	$155.80
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $263.48 / $328.16 / $443.02	Professional	TC	$263.48	$328.16	$443.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $345.39 / $460.52 / $844.29	Professional		$345.39	$460.52	$844.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $103.87 / $149.57 / $400.00	Professional	26	$103.87	$149.57	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $279.77 / $384.86 / $750.00	Professional	TC	$279.77	$384.86	$750.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $954.08 / $954.08 / $973.04	Facility	26	$954.08	$954.08	$973.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,025.38 / $6,206.15 / $6,206.15	Professional		$6,025.38	$6,206.15	$6,206.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $891.52 / $891.52 / $891.52	Professional	26	$891.52	$891.52	$891.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,457.89 / $5,621.63 / $5,621.63	Professional	TC	$5,457.89	$5,621.63	$5,621.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $356.24	Professional		$32.34	$32.34	$356.24
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $343.14 / $769.14 / $1,443.28	Professional		$343.14	$769.14	$1,443.28
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.06 / $127.05 / $281.08	Professional	26	$64.06	$127.05	$281.08
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $244.08 / $553.88 / $1,354.73	Professional	TC	$244.08	$553.88	$1,354.73
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,306.42 / $1,306.42 / $1,306.42	Professional		$1,306.42	$1,306.42	$1,306.42
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $356.62 / $356.62 / $356.62	Professional	26	$356.62	$356.62	$356.62
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $949.79 / $949.79 / $949.79	Professional	TC	$949.79	$949.79	$949.79
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $358.72 / $466.93 / $566.99	Professional		$358.72	$466.93	$566.99
United Facility/Professional Professional Modifier Low / Median / High Price $337.75 / $567.20 / $1,321.59	Professional		$337.75	$567.20	$1,321.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.12 / $114.84 / $277.97	Professional	26	$87.12	$114.84	$277.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $242.65 / $473.42 / $995.58	Professional	TC	$242.65	$473.42	$995.58