Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.50 / $115.90 / $615.08	Facility	26	$112.50	$115.90	$615.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $315.33 / $378.55 / $1,876.56	Professional		$315.33	$378.55	$1,876.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $98.56 / $112.50 / $560.90	Professional	26	$98.56	$112.50	$560.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $207.65 / $238.79 / $1,315.67	Professional	TC	$207.65	$238.79	$1,315.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $304.57 / $470.48 / $1,034.60	Professional		$304.57	$470.48	$1,034.60
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $108.78 / $161.37 / $310.43	Professional	26	$108.78	$161.37	$310.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.70 / $303.11 / $735.08	Professional	TC	$194.70	$303.11	$735.08
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $210.91 / $346.10 / $843.87	Professional		$210.91	$346.10	$843.87
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.52 / $116.42 / $286.02	Professional	26	$83.52	$116.42	$286.02
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $135.30 / $224.92 / $559.74	Professional	TC	$135.30	$224.92	$559.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $319.39 / $477.91 / $1,268.40	Professional		$319.39	$477.91	$1,268.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.39 / $141.16 / $412.21	Professional	26	$108.39	$141.16	$412.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.15 / $333.63 / $855.67	Professional	TC	$213.15	$333.63	$855.67
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $209.68 / $314.52 / $526.17	Professional		$209.68	$314.52	$526.17
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.58 / $114.14 / $136.97	Professional	26	$77.58	$114.14	$136.97
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.52 / $320.19 / $389.21	Professional	TC	$158.52	$320.19	$389.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $354.02 / $474.44 / $836.09	Professional		$354.02	$474.44	$836.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.73 / $143.05 / $262.52	Professional	26	$102.73	$143.05	$262.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $264.35 / $387.45 / $745.98	Professional	TC	$264.35	$387.45	$745.98
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $243.55 / $473.80 / $507.92	Facility	26	$243.55	$473.80	$507.92
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,451.44 / $2,710.64 / $2,864.93	Professional		$2,451.44	$2,710.64	$2,864.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $764.48 / $785.60 / $859.80	Professional	26	$764.48	$785.60	$859.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,717.44 / $1,925.04 / $2,005.13	Professional	TC	$1,717.44	$1,925.04	$2,005.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $327.38 / $505.84 / $1,046.02	Professional		$327.38	$505.84	$1,046.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $109.40 / $140.69 / $335.08	Professional	26	$109.40	$140.69	$335.08
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $213.15 / $333.63 / $790.63	Professional	TC	$213.15	$333.63	$790.63
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,164.35 / $1,164.35 / $1,164.35	Professional		$1,164.35	$1,164.35	$1,164.35
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $348.01 / $348.01 / $348.01	Professional	26	$348.01	$348.01	$348.01
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $816.35 / $816.35 / $816.35	Professional	TC	$816.35	$816.35	$816.35
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $209.68 / $356.45 / $487.50	Professional		$209.68	$356.45	$487.50
United Facility/Professional Professional Modifier Low / Median / High Price $276.64 / $392.30 / $1,143.55	Professional		$276.64	$392.30	$1,143.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.93 / $135.53 / $355.66	Professional	26	$88.93	$135.53	$355.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $183.60 / $278.80 / $872.71	Professional	TC	$183.60	$278.80	$872.71