Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $309.03 / $426.58 / $575.44	Facility	26	$309.03	$426.58	$575.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,258.93 / $4,897.79	Professional		$1,023.29	$1,258.93	$4,897.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $281.84 / $407.38 / $1,318.26	Professional	26	$281.84	$407.38	$1,318.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $851.14 / $1,905.46	Professional	TC	$724.44	$851.14	$1,905.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $1,023.29	Professional		$1,023.29	$1,023.29	$1,023.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $302.00 / $630.96	Professional	26	$229.09	$302.00	$630.96
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $2,344.23 / $4,570.88	Professional		$1,584.89	$2,344.23	$4,570.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $426.58 / $645.65 / $1,202.26	Professional	26	$426.58	$645.65	$1,202.26
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,148.15 / $1,698.24 / $3,388.44	Professional	TC	$1,148.15	$1,698.24	$3,388.44
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,479.11 / $3,467.37	Professional		$1,000.00	$1,479.11	$3,467.37
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $380.19 / $870.96	Professional	26	$263.03	$380.19	$870.96
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $741.31 / $1,096.48 / $2,570.40	Professional	TC	$741.31	$1,096.48	$2,570.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,445.44 / $3,467.37	Professional		$1,148.15	$1,445.44	$3,467.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $316.23 / $389.05 / $954.99	Professional	26	$316.23	$389.05	$954.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $831.76 / $1,071.52 / $2,454.71	Professional	TC	$831.76	$1,071.52	$2,454.71
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,202.26 / $1,659.59	Professional		$954.99	$1,202.26	$1,659.59
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $257.04 / $309.03 / $389.05	Professional	26	$257.04	$309.03	$389.05
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $1,023.29 / $1,380.38	Professional	TC	$691.83	$1,023.29	$1,380.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,348.96 / $2,454.71	Professional		$1,023.29	$1,348.96	$2,454.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $281.84 / $389.05 / $724.44	Professional	26	$281.84	$389.05	$724.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $794.33 / $1,202.26 / $2,344.23	Professional	TC	$794.33	$1,202.26	$2,344.23
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $2,570.40 / $2,570.40 / $2,570.40	Facility	26	$2,570.40	$2,570.40	$2,570.40
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,918.31 / $8,317.64 / $8,317.64	Professional		$6,918.31	$8,317.64	$8,317.64
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,778.28 / $2,398.83 / $2,398.83	Professional	26	$1,778.28	$2,398.83	$2,398.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $5,128.61 / $6,025.60 / $6,025.60	Professional	TC	$5,128.61	$6,025.60	$6,025.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $1,000.00 / $1,412.54	Professional		$426.58	$1,000.00	$1,412.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,445.44 / $3,467.37	Professional		$1,148.15	$1,445.44	$3,467.37
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $316.23 / $389.05 / $891.25	Professional	26	$316.23	$389.05	$891.25
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $831.76 / $1,047.13 / $2,454.71	Professional	TC	$831.76	$1,047.13	$2,454.71
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $3,548.13 / $3,548.13 / $3,548.13	Professional		$3,548.13	$3,548.13	$3,548.13
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $933.25 / $933.25 / $933.25	Professional	26	$933.25	$933.25	$933.25
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $2,630.27 / $2,630.27 / $2,630.27	Professional	TC	$2,630.27	$2,630.27	$2,630.27
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,412.54 / $2,041.74	Professional		$1,096.48	$1,412.54	$2,041.74
United Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,318.26 / $2,884.03	Professional		$891.25	$1,318.26	$2,884.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $251.19 / $380.19 / $794.33	Professional	26	$251.19	$380.19	$794.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $912.01 / $2,187.76	Professional	TC	$630.96	$912.01	$2,187.76