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 / $667.22	Facility	26	$140.00	$140.00	$667.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $360.87 / $475.00 / $1,964.80	Professional		$360.87	$475.00	$1,964.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.14 / $140.00 / $544.50	Professional	26	$107.14	$140.00	$544.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $224.32 / $335.00 / $692.74	Professional	TC	$224.32	$335.00	$692.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $286.70 / $455.02 / $1,849.53	Professional		$286.70	$455.02	$1,849.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $82.56 / $165.12 / $246.22	Professional	26	$82.56	$165.12	$246.22
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $151.55 / $151.55 / $313.83	Professional	TC	$151.55	$151.55	$313.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $393.10 / $652.07 / $1,178.25	Professional		$393.10	$652.07	$1,178.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $115.03 / $174.46 / $320.89	Professional	26	$115.03	$174.46	$320.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $273.31 / $473.44 / $857.36	Professional	TC	$273.31	$473.44	$857.36
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $303.52 / $469.67 / $1,133.27	Professional		$303.52	$469.67	$1,133.27
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $91.50 / $125.16 / $294.93	Professional	26	$91.50	$125.16	$294.93
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $220.02 / $344.51 / $827.41	Professional	TC	$220.02	$344.51	$827.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.62 / $124.62 / $124.62	Facility	26	$124.62	$124.62	$124.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $258.76 / $485.45 / $1,152.51	Professional		$258.76	$485.45	$1,152.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.34 / $133.63 / $305.48	Professional	26	$63.34	$133.63	$305.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $187.51 / $344.13 / $822.12	Professional	TC	$187.51	$344.13	$822.12
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $337.84 / $448.15 / $605.00	Professional		$337.84	$448.15	$605.00
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.22 / $120.91 / $163.22	Professional	26	$91.22	$120.91	$163.22
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $246.62 / $327.24 / $441.77	Professional	TC	$246.62	$327.24	$441.77
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $315.00 / $315.00 / $315.00	Professional	26	$315.00	$315.00	$315.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $339.39 / $450.20 / $853.91	Professional		$339.39	$450.20	$853.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $108.82 / $151.13 / $400.00	Professional	26	$108.82	$151.13	$400.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $278.98 / $383.78 / $750.00	Professional	TC	$278.98	$383.78	$750.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $999.76 / $999.76 / $1,020.08	Facility	26	$999.76	$999.76	$1,020.08
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,337.81 / $2,337.81 / $2,907.38	Professional		$2,337.81	$2,337.81	$2,907.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $687.65 / $687.65 / $881.25	Professional	26	$687.65	$687.65	$881.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,650.16 / $1,650.16 / $2,026.13	Professional	TC	$1,650.16	$1,650.16	$2,026.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $270.08	Professional		$32.34	$32.34	$270.08
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $124.62 / $124.62 / $124.62	Facility	26	$124.62	$124.62	$124.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $277.36 / $561.66 / $1,091.34	Professional		$277.36	$561.66	$1,091.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.06 / $129.63 / $302.72	Professional	26	$60.06	$129.63	$302.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $157.24 / $337.31 / $822.12	Professional	TC	$157.24	$337.31	$822.12
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,326.44 / $1,326.44 / $1,326.44	Professional		$1,326.44	$1,326.44	$1,326.44
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $374.25 / $374.25 / $374.25	Professional	26	$374.25	$374.25	$374.25
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $952.19 / $952.19 / $952.19	Professional	TC	$952.19	$952.19	$952.19
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $362.42 / $472.98 / $574.33	Professional		$362.42	$472.98	$574.33
United Facility/Professional Professional Modifier Low / Median / High Price $343.26 / $584.64 / $1,341.48	Professional		$343.26	$584.64	$1,341.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.63 / $113.88 / $276.99	Professional	26	$65.63	$113.88	$276.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $243.26 / $427.41 / $1,068.47	Professional	TC	$243.26	$427.41	$1,068.47