Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $186.21 / $676.08	Facility	26	$123.03	$186.21	$676.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $831.76 / $3,090.30	Professional		$630.96	$831.76	$3,090.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $199.53 / $602.56	Professional	26	$120.23	$199.53	$602.56
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $295.12 / $1,258.93	Professional	52	$199.53	$295.12	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $691.83 / $2,041.74	Professional	TC	$478.63	$691.83	$2,041.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $645.65 / $1,148.15	Professional		$549.54	$645.65	$1,148.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $123.03 / $165.96	Professional	26	$112.20	$123.03	$165.96
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $141.25 / $141.25 / $141.25	Professional	52	$141.25	$141.25	$141.25
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $524.81 / $524.81	Professional	TC	$524.81	$524.81	$524.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $933.25 / $1,905.46	Professional		$616.60	$933.25	$1,905.46
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $251.19 / $426.58	Professional	26	$128.82	$251.19	$426.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $724.44 / $1,584.89	Professional	TC	$380.19	$724.44	$1,584.89
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $794.33 / $1,584.89	Professional		$602.56	$794.33	$1,584.89
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $134.90 / $275.42	Professional	26	$107.15	$134.90	$275.42
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $660.69 / $1,318.26	Professional	TC	$501.19	$660.69	$1,318.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $1,000.00 / $1,778.28	Professional		$691.83	$1,000.00	$1,778.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $186.21 / $331.13	Professional	26	$131.83	$186.21	$331.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $812.83 / $1,479.11	Professional	TC	$575.44	$812.83	$1,479.11
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $537.03 / $1,202.26	Professional		$354.81	$537.03	$1,202.26
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $169.82 / $213.80	Professional	26	$144.54	$169.82	$213.80
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $281.84 / $1,023.29	Professional	TC	$190.55	$281.84	$1,023.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $870.96 / $1,445.44	Professional		$691.83	$870.96	$1,445.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $131.83 / $229.09	Professional	26	$117.49	$131.83	$229.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $758.58 / $1,230.27	Professional	TC	$630.96	$758.58	$1,230.27
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $6,165.95 / $6,165.95 / $6,165.95	Professional		$6,165.95	$6,165.95	$6,165.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $1,071.52 / $1,071.52 / $1,071.52	Professional	26	$1,071.52	$1,071.52	$1,071.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,981.07 / $4,570.88 / $4,570.88	Professional	TC	$3,981.07	$4,570.88	$4,570.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $707.95 / $891.25	Professional		$173.78	$707.95	$891.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $1,047.13 / $1,698.24	Professional		$707.95	$1,047.13	$1,698.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $190.55 / $309.03	Professional	26	$131.83	$190.55	$309.03
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $812.83 / $1,479.11	Professional	TC	$575.44	$812.83	$1,479.11
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,137.96 / $2,137.96	Professional		$2,137.96	$2,137.96	$2,137.96
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $416.87 / $416.87 / $416.87	Professional	26	$416.87	$416.87	$416.87
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,737.80 / $1,737.80 / $1,737.80	Professional	TC	$1,737.80	$1,737.80	$1,737.80
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $812.83 / $1,096.48	Professional		$457.09	$812.83	$1,096.48
United Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $794.33 / $1,621.81	Professional		$524.81	$794.33	$1,621.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $162.18 / $309.03	Professional	26	$102.33	$162.18	$309.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $645.65 / $1,318.26	Professional	TC	$426.58	$645.65	$1,318.26