Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $289.42 / $326.70 / $1,645.14	Facility	26	$289.42	$326.70	$1,645.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,012.82 / $1,133.92 / $2,974.74	Professional		$1,012.82	$1,133.92	$2,974.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $284.62 / $341.57 / $1,326.81	Professional	26	$284.62	$341.57	$1,326.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $728.19 / $815.25 / $1,925.74	Professional	TC	$728.19	$815.25	$1,925.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $229.51 / $254.04 / $628.29	Professional	26	$229.51	$254.04	$628.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,445.28 / $2,142.33 / $3,900.00	Professional		$1,445.28	$2,142.33	$3,900.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $406.16 / $580.54 / $1,036.39	Professional	26	$406.16	$580.54	$1,036.39
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,039.11 / $1,540.28 / $2,855.69	Professional	TC	$1,039.11	$1,540.28	$2,855.69
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $777.74 / $1,174.25 / $2,665.34	Professional		$777.74	$1,174.25	$2,665.34
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $204.04 / $302.48 / $673.99	Professional	26	$204.04	$302.48	$673.99
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $573.70 / $871.94 / $2,009.65	Professional	TC	$573.70	$871.94	$2,009.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,138.00 / $1,428.61 / $3,588.77	Professional		$1,138.00	$1,428.61	$3,588.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $309.38 / $384.90 / $1,024.30	Professional	26	$309.38	$384.90	$1,024.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $818.48 / $1,039.04 / $2,831.86	Professional	TC	$818.48	$1,039.04	$2,831.86
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $950.01 / $1,204.89 / $1,653.78	Professional		$950.01	$1,204.89	$1,653.78
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $256.50 / $301.10 / $391.43	Professional	26	$256.50	$301.10	$391.43
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $693.51 / $971.04 / $2,321.39	Professional	TC	$693.51	$971.04	$2,321.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,019.41 / $1,292.73 / $2,429.83	Professional		$1,019.41	$1,292.73	$2,429.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $270.99 / $377.43 / $692.53	Professional	26	$270.99	$377.43	$692.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $791.38 / $1,138.52 / $2,233.39	Professional	TC	$791.38	$1,138.52	$2,233.39
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2,118.00 / $2,579.04 / $2,654.96	Facility	26	$2,118.00	$2,579.04	$2,654.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,888.39 / $6,888.39 / $8,413.43	Professional		$6,888.39	$6,888.39	$8,413.43
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,791.90 / $1,791.90 / $2,413.42	Professional	26	$1,791.90	$1,791.90	$2,413.42
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,096.49 / $5,096.49 / $5,999.93	Professional	TC	$5,096.49	$5,096.49	$5,999.93
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,131.79 / $1,413.71 / $3,309.82	Professional		$1,131.79	$1,413.71	$3,309.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $318.19 / $390.73 / $944.68	Professional	26	$318.19	$390.73	$944.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $820.99 / $1,043.74 / $2,564.46	Professional	TC	$820.99	$1,043.74	$2,564.46
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $3,567.66 / $3,567.66 / $3,567.66	Professional		$3,567.66	$3,567.66	$3,567.66
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $943.73 / $943.73 / $943.73	Professional	26	$943.73	$943.73	$943.73
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $2,623.92 / $2,623.92 / $2,623.92	Professional	TC	$2,623.92	$2,623.92	$2,623.92
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $950.01 / $1,330.02 / $1,807.34	Professional		$950.01	$1,330.02	$1,807.34
United Facility/Professional Professional Modifier Low / Median / High Price $881.89 / $1,261.64 / $3,661.64	Professional		$881.89	$1,261.64	$3,661.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $248.24 / $371.65 / $1,045.48	Professional	26	$248.24	$371.65	$1,045.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $630.84 / $895.84 / $2,223.52	Professional	TC	$630.84	$895.84	$2,223.52