Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.97 / $97.66 / $591.17	Facility	26	$94.97	$97.66	$591.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $755.31 / $1,034.60 / $4,109.00	Professional		$755.31	$1,034.60	$4,109.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.07 / $122.80 / $511.74	Professional	26	$90.07	$122.80	$511.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $677.79 / $849.38 / $3,713.40	Professional	TC	$677.79	$849.38	$3,713.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $157.79 / $157.79 / $157.79	Professional	26	$157.79	$157.79	$157.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $918.97 / $1,511.29 / $3,075.22	Professional		$918.97	$1,511.29	$3,075.22
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.70 / $152.44 / $310.11	Professional	26	$102.70	$152.44	$310.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $812.60 / $1,358.84 / $2,765.10	Professional	TC	$812.60	$1,358.84	$2,765.10
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $719.76 / $1,111.05 / $2,755.40	Professional		$719.76	$1,111.05	$2,755.40
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $96.68 / $111.75 / $274.81	Professional	26	$96.68	$111.75	$274.81
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $644.57 / $999.30 / $2,478.26	Professional	TC	$644.57	$999.30	$2,478.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $509.10 / $1,125.30 / $2,791.43	Professional		$509.10	$1,125.30	$2,791.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.30 / $117.12 / $280.94	Professional	26	$53.30	$117.12	$280.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $455.80 / $1,003.53 / $2,507.92	Professional	TC	$455.80	$1,003.53	$2,507.92
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $822.94 / $1,073.97 / $1,449.86	Professional		$822.94	$1,073.97	$1,449.86
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.29 / $106.05 / $143.16	Professional	26	$82.29	$106.05	$143.16
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $740.65 / $967.92 / $1,306.69	Professional	TC	$740.65	$967.92	$1,306.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $777.24 / $1,051.56 / $2,011.68	Professional		$777.24	$1,051.56	$2,011.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.33 / $127.26 / $223.17	Professional	26	$87.33	$127.26	$223.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $742.83 / $1,072.79 / $1,819.69	Professional	TC	$742.83	$1,072.79	$1,819.69
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $229.45 / $432.95 / $468.97	Facility	26	$229.45	$432.95	$468.97
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $5,628.92 / $5,628.92 / $6,769.20	Professional		$5,628.92	$5,628.92	$6,769.20
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $611.21 / $611.21 / $766.58	Professional	26	$611.21	$611.21	$766.58
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,017.71 / $5,017.71 / $6,002.63	Professional	TC	$5,017.71	$5,017.71	$6,002.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $509.10 / $1,088.95 / $2,781.35	Professional		$509.10	$1,088.95	$2,781.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $53.30 / $117.12 / $276.20	Professional	26	$53.30	$117.12	$276.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $455.80 / $997.56 / $2,507.92	Professional	TC	$455.80	$997.56	$2,507.92
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $3,162.66 / $3,162.66 / $3,162.66	Professional		$3,162.66	$3,162.66	$3,162.66
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $332.98 / $332.98 / $332.98	Professional	26	$332.98	$332.98	$332.98
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $2,829.67 / $2,829.67 / $2,829.67	Professional	TC	$2,829.67	$2,829.67	$2,829.67
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $868.70 / $1,152.11 / $1,399.00	Professional		$868.70	$1,152.11	$1,399.00
United Facility/Professional Professional Modifier Low / Median / High Price $752.56 / $955.65 / $2,929.57	Professional		$752.56	$955.65	$2,929.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.42 / $115.13 / $298.91	Professional	26	$82.42	$115.13	$298.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $670.14 / $850.99 / $3,135.10	Professional	TC	$670.14	$850.99	$3,135.10