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 / $516.28	Facility	26	$140.00	$140.00	$516.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.50 / $475.00 / $2,252.02	Professional		$370.50	$475.00	$2,252.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.19 / $140.00 / $463.00	Professional	26	$90.19	$140.00	$463.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.98 / $335.00 / $848.92	Professional	TC	$259.98	$335.00	$848.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $214.13 / $214.13 / $214.13	Professional		$214.13	$214.13	$214.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.87 / $63.87 / $63.87	Professional	26	$63.87	$63.87	$63.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $406.67 / $696.41 / $1,221.13	Professional		$406.67	$696.41	$1,221.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.65 / $114.50 / $232.65	Professional	26	$80.65	$114.50	$232.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $315.39 / $575.26 / $1,006.61	Professional	TC	$315.39	$575.26	$1,006.61
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $334.10 / $514.28 / $1,249.28	Professional		$334.10	$514.28	$1,249.28
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.28 / $107.53 / $260.83	Professional	26	$79.28	$107.53	$260.83
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $261.92 / $407.63 / $978.66	Professional	TC	$261.92	$407.63	$978.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.43 / $571.42 / $1,147.03	Professional		$295.43	$571.42	$1,147.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.40 / $104.13 / $236.89	Professional	26	$51.40	$104.13	$236.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $249.89 / $453.80 / $923.71	Professional	TC	$249.89	$453.80	$923.71
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $332.03 / $446.79 / $603.16	Professional		$332.03	$446.79	$603.16
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.73 / $93.24 / $125.87	Professional	26	$69.73	$93.24	$125.87
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $262.30 / $353.54 / $477.28	Professional	TC	$262.30	$353.54	$477.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $342.61 / $442.45 / $808.76	Professional		$342.61	$442.45	$808.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $82.77 / $111.89 / $209.79	Professional	26	$82.77	$111.89	$209.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $272.60 / $406.57 / $663.02	Professional	TC	$272.60	$406.57	$663.02
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $772.96 / $772.96 / $789.92	Facility	26	$772.96	$772.96	$789.92
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,007.15 / $3,039.70 / $3,039.70	Professional		$3,007.15	$3,039.70	$3,039.70
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $848.54 / $848.54 / $848.54	Professional	26	$848.54	$848.54	$848.54
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,544.17 / $2,573.94 / $2,613.88	Professional	TC	$2,544.17	$2,573.94	$2,613.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $271.27	Professional		$32.34	$32.34	$271.27
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $309.67 / $648.21 / $1,090.18	Professional		$309.67	$648.21	$1,090.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $102.49 / $228.31	Professional	26	$51.23	$102.49	$228.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $248.45 / $453.80 / $891.39	Professional	TC	$248.45	$453.80	$891.39
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,295.84 / $1,295.84 / $1,295.84	Professional		$1,295.84	$1,295.84	$1,295.84
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $290.11 / $290.11 / $290.11	Professional	26	$290.11	$290.11	$290.11
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,005.73 / $1,005.73 / $1,005.73	Professional	TC	$1,005.73	$1,005.73	$1,005.73
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $361.34 / $496.85 / $1,117.80	Professional		$361.34	$496.85	$1,117.80
United Facility/Professional Professional Modifier Low / Median / High Price $334.68 / $446.20 / $1,025.69	Professional		$334.68	$446.20	$1,025.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.69 / $91.31 / $224.72	Professional	26	$69.69	$91.31	$224.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.07 / $377.10 / $808.40	Professional	TC	$257.07	$377.10	$808.40