Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.22 / $131.91 / $707.41	Facility	26	$118.22	$131.91	$707.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $604.58 / $761.38 / $2,372.42	Professional		$604.58	$761.38	$2,372.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $113.37 / $140.30 / $589.00	Professional	26	$113.37	$140.30	$589.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $264.81 / $325.26 / $627.09	Professional	52	$264.81	$325.26	$627.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $460.37 / $619.99 / $2,000.00	Professional	TC	$460.37	$619.99	$2,000.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $579.34 / $606.98 / $1,321.45	Professional		$579.34	$606.98	$1,321.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $101.06 / $113.94 / $220.25	Professional	26	$101.06	$113.94	$220.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $547.55 / $824.05 / $1,730.05	Professional		$547.55	$824.05	$1,730.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $106.00 / $166.06 / $370.02	Professional	26	$106.00	$166.06	$370.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $385.53 / $663.68 / $1,395.07	Professional	TC	$385.53	$663.68	$1,395.07
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $425.01 / $637.32 / $1,519.94	Professional		$425.01	$637.32	$1,519.94
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $78.62 / $107.25 / $260.25	Professional	26	$78.62	$107.25	$260.25
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $351.55 / $530.05 / $1,249.79	Professional	TC	$351.55	$530.05	$1,249.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $672.85 / $961.59 / $1,879.20	Professional		$672.85	$961.59	$1,879.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.29 / $181.69 / $341.77	Professional	26	$125.29	$181.69	$341.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $545.65 / $786.49 / $1,520.74	Professional	TC	$545.65	$786.49	$1,520.74
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $348.07 / $529.75 / $1,119.22	Professional		$348.07	$529.75	$1,119.22
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $129.97 / $156.63 / $198.66	Professional	26	$129.97	$156.63	$198.66
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $191.44 / $291.36 / $943.73	Professional	TC	$191.44	$291.36	$943.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $619.97 / $781.30 / $1,383.00	Professional		$619.97	$781.30	$1,383.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.97 / $131.35 / $272.18	Professional	26	$107.97	$131.35	$272.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $539.58 / $699.06 / $1,188.40	Professional	TC	$539.58	$699.06	$1,188.40
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $275.57 / $701.13 / $701.13	Facility	26	$275.57	$701.13	$701.13
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,200.00 / $6,200.00 / $6,200.00	Professional		$6,200.00	$6,200.00	$6,200.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2,600.00 / $2,600.00 / $2,600.00	Professional	26	$2,600.00	$2,600.00	$2,600.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $7,000.00 / $7,000.00 / $7,000.00	Professional	TC	$7,000.00	$7,000.00	$7,000.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $849.28	Professional		$32.34	$32.34	$849.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $710.27 / $1,069.83 / $1,695.50	Professional		$710.27	$1,069.83	$1,695.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $127.48 / $187.23 / $324.62	Professional	26	$127.48	$187.23	$324.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $555.88 / $800.83 / $1,520.74	Professional	TC	$555.88	$800.83	$1,520.74
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $2,045.25 / $2,045.25 / $2,045.25	Professional		$2,045.25	$2,045.25	$2,045.25
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $397.19 / $397.19 / $397.19	Professional	26	$397.19	$397.19	$397.19
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,648.05 / $1,648.05 / $1,648.05	Professional	TC	$1,648.05	$1,648.05	$1,648.05
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $522.11 / $754.33 / $949.84	Professional		$522.11	$754.33	$949.84
United Facility/Professional Professional Modifier Low / Median / High Price $481.88 / $740.03 / $1,851.07	Professional		$481.88	$740.03	$1,851.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $96.60 / $155.25 / $327.27	Professional	26	$96.60	$155.25	$327.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $385.28 / $590.79 / $1,438.51	Professional	TC	$385.28	$590.79	$1,438.51