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 / $741.72	Facility	26	$140.00	$140.00	$741.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.27 / $475.00 / $2,686.27	Professional		$400.27	$475.00	$2,686.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.84 / $154.00 / $559.33	Professional	26	$125.84	$154.00	$559.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $262.50 / $335.00 / $783.89	Professional	TC	$262.50	$335.00	$783.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $408.45 / $645.38 / $807.74	Professional		$408.45	$645.38	$807.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $97.53 / $229.93 / $595.00	Professional	26	$97.53	$229.93	$595.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $431.86 / $769.26 / $1,455.42	Professional		$431.86	$769.26	$1,455.42
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $118.36 / $161.06 / $312.60	Professional	26	$118.36	$161.06	$312.60
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $294.44 / $605.78 / $1,154.97	Professional	TC	$294.44	$605.78	$1,154.97
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $349.65 / $535.78 / $1,310.52	Professional		$349.65	$535.78	$1,310.52
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $103.26 / $153.57 / $374.28	Professional	26	$103.26	$153.57	$374.28
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $246.39 / $383.48 / $922.00	Professional	TC	$246.39	$383.48	$922.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.98 / $651.37 / $1,276.58	Professional		$323.98	$651.37	$1,276.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.84 / $146.88 / $339.87	Professional	26	$73.84	$146.88	$339.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $240.53 / $471.05 / $960.26	Professional	TC	$240.53	$471.05	$960.26
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $361.03 / $470.96 / $635.79	Professional		$361.03	$470.96	$635.79
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.70 / $135.46 / $182.87	Professional	26	$104.70	$135.46	$182.87
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $256.33 / $335.50 / $452.93	Professional	TC	$256.33	$335.50	$452.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $363.59 / $478.96 / $898.59	Professional		$363.59	$478.96	$898.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $121.91 / $169.33 / $400.00	Professional	26	$121.91	$169.33	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $286.02 / $393.46 / $750.00	Professional	TC	$286.02	$393.46	$750.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,118.24 / $1,118.24 / $1,142.00	Facility	26	$1,118.24	$1,118.24	$1,142.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,919.13 / $4,036.70 / $4,036.70	Professional		$3,919.13	$4,036.70	$4,036.70
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $771.93 / $771.93 / $980.18	Professional	26	$771.93	$771.93	$980.18
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,292.02 / $3,390.79 / $3,390.79	Professional	TC	$3,292.02	$3,390.79	$3,390.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $254.88	Professional		$32.34	$32.34	$254.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $356.02 / $722.63 / $1,190.86	Professional		$356.02	$722.63	$1,190.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $73.70 / $140.07 / $331.31	Professional	26	$73.70	$140.07	$331.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $239.35 / $492.79 / $923.24	Professional	TC	$239.35	$492.79	$923.24
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,401.78 / $1,401.78 / $1,401.78	Professional		$1,401.78	$1,401.78	$1,401.78
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $415.93 / $415.93 / $415.93	Professional	26	$415.93	$415.93	$415.93
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $985.85 / $985.85 / $985.85	Professional	TC	$985.85	$985.85	$985.85
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $380.88 / $505.44 / $613.75	Professional		$380.88	$505.44	$613.75
United Facility/Professional Professional Modifier Low / Median / High Price $362.59 / $538.44 / $1,210.21	Professional		$362.59	$538.44	$1,210.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.78 / $131.40 / $309.05	Professional	26	$97.78	$131.40	$309.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.85 / $374.00 / $916.51	Professional	TC	$251.85	$374.00	$916.51