Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.67 / $136.24 / $734.35	Facility	26	$123.67	$136.24	$734.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $633.16 / $821.92 / $3,067.00	Professional		$633.16	$821.92	$3,067.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.84 / $141.65 / $576.00	Professional	26	$117.84	$141.65	$576.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $276.43 / $342.47 / $516.49	Professional	52	$276.43	$342.47	$516.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $481.29 / $655.83 / $1,607.92	Professional	TC	$481.29	$655.83	$1,607.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $550.52 / $653.74 / $1,176.63	Professional		$550.52	$653.74	$1,176.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $105.19 / $141.44 / $158.35	Professional	26	$105.19	$141.44	$158.35
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $579.36 / $885.20 / $1,887.32	Professional		$579.36	$885.20	$1,887.32
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $110.90 / $174.31 / $387.47	Professional	26	$110.90	$174.31	$387.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $412.51 / $716.51 / $1,548.30	Professional	TC	$412.51	$716.51	$1,548.30
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $445.78 / $668.52 / $1,594.13	Professional		$445.78	$668.52	$1,594.13
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $81.64 / $111.43 / $270.37	Professional	26	$81.64	$111.43	$270.37
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $369.47 / $557.09 / $1,313.49	Professional	TC	$369.47	$557.09	$1,313.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $697.16 / $1,017.45 / $1,952.63	Professional		$697.16	$1,017.45	$1,952.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $130.00 / $193.60 / $354.66	Professional	26	$130.00	$193.60	$354.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $574.53 / $834.28 / $1,613.36	Professional	TC	$574.53	$834.28	$1,613.36
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $357.72 / $544.42 / $1,172.06	Professional		$357.72	$544.42	$1,172.06
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.16 / $168.13 / $213.23	Professional	26	$135.16	$168.13	$213.23
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $189.59 / $288.55 / $989.59	Professional	TC	$189.59	$288.55	$989.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $638.07 / $818.21 / $1,420.72	Professional		$638.07	$818.21	$1,420.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.37 / $136.57 / $283.29	Professional	26	$112.37	$136.57	$283.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $565.75 / $733.03 / $1,246.15	Professional	TC	$565.75	$733.03	$1,246.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $286.83 / $753.90 / $753.90	Facility	26	$286.83	$753.90	$753.90
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 $1,081.48 / $1,081.48 / $1,081.48	Professional	26	$1,081.48	$1,081.48	$1,081.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,875.48 / $3,991.74 / $4,567.58	Professional	TC	$3,875.48	$3,991.74	$4,567.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $887.90	Professional		$32.34	$32.34	$887.90
Providence Facility/Professional Professional Modifier Low / Median / High Price $743.83 / $1,124.71 / $1,780.47	Professional		$743.83	$1,124.71	$1,780.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $132.34 / $197.31 / $337.53	Professional	26	$132.34	$197.31	$337.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $583.17 / $874.72 / $1,613.36	Professional	TC	$583.17	$874.72	$1,613.36
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $2,137.31 / $2,137.31 / $2,137.31	Professional		$2,137.31	$2,137.31	$2,137.31
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $412.32 / $412.32 / $412.32	Professional	26	$412.32	$412.32	$412.32
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,724.98 / $1,724.98 / $1,724.98	Professional	TC	$1,724.98	$1,724.98	$1,724.98
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $536.58 / $789.94 / $976.16	Professional		$536.58	$789.94	$976.16
United Facility/Professional Professional Modifier Low / Median / High Price $503.44 / $791.12 / $1,973.93	Professional		$503.44	$791.12	$1,973.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $100.24 / $161.10 / $347.61	Professional	26	$100.24	$161.10	$347.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $408.51 / $627.88 / $1,577.35	Professional	TC	$408.51	$627.88	$1,577.35