Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.49 / $94.75 / $489.24	Facility	26	$91.49	$94.75	$489.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $306.00 / $348.07 / $1,469.19	Professional		$306.00	$348.07	$1,469.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.09 / $91.48 / $332.64	Professional	26	$84.09	$91.48	$332.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $221.90 / $256.57 / $953.94	Professional	TC	$221.90	$256.57	$953.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $273.47 / $445.90 / $909.65	Professional		$273.47	$445.90	$909.65
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.20 / $131.15 / $265.02	Professional	26	$89.20	$131.15	$265.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.75 / $323.97 / $651.85	Professional	TC	$57.75	$323.97	$651.85
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $250.66 / $406.34 / $948.12	Professional		$250.66	$406.34	$948.12
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $105.04 / $259.98	Professional	26	$77.62	$105.04	$259.98
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $181.78 / $301.23 / $700.01	Professional	TC	$181.78	$301.23	$700.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $311.31 / $431.61 / $1,211.94	Professional		$311.31	$431.61	$1,211.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.89 / $111.94 / $338.80	Professional	26	$85.89	$111.94	$338.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.89 / $319.70 / $909.14	Professional	TC	$213.89	$319.70	$909.14
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $91.21 / $138.04 / $429.49	Professional		$91.21	$138.04	$429.49
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.19 / $44.17 / $109.68	Professional	26	$29.19	$44.17	$109.68
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.02 / $183.25 / $319.81	Professional	TC	$62.02	$183.25	$319.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $288.61 / $387.02 / $697.79	Professional		$288.61	$387.02	$697.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $82.26 / $114.49 / $210.22	Professional	26	$82.26	$114.49	$210.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $217.24 / $318.39 / $612.97	Professional	TC	$217.24	$318.39	$612.97
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $195.59 / $378.47 / $406.32	Facility	26	$195.59	$378.47	$406.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,999.20 / $2,227.92 / $2,332.94	Professional		$1,999.20	$2,227.92	$2,332.94
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $684.00 / $684.00 / $684.30	Professional	26	$684.00	$684.00	$684.30
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,517.19 / $1,600.96 / $1,648.65	Professional	TC	$1,517.19	$1,600.96	$1,648.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $311.31 / $438.56 / $969.30	Professional		$311.31	$438.56	$969.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $87.69 / $111.94 / $254.83	Professional	26	$87.69	$111.94	$254.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $216.53 / $324.00 / $737.53	Professional	TC	$216.53	$324.00	$737.53
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $972.45 / $972.45 / $972.45	Professional		$972.45	$972.45	$972.45
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $276.32 / $276.32 / $276.32	Professional	26	$276.32	$276.32	$276.32
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $696.13 / $696.13 / $696.13	Professional	TC	$696.13	$696.13	$696.13
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $91.21 / $161.04 / $397.93	Professional		$91.21	$161.04	$397.93
United Facility/Professional Professional Modifier Low / Median / High Price $230.44 / $383.18 / $1,210.81	Professional		$230.44	$383.18	$1,210.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.16 / $104.32 / $281.73	Professional	26	$70.16	$104.32	$281.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.40 / $264.20 / $649.96	Professional	TC	$162.40	$264.20	$649.96