Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $114.82 / $616.60	Facility	26	$112.20	$114.82	$616.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $407.38 / $2,137.96	Professional		$338.84	$407.38	$2,137.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $123.03 / $436.52	Professional	26	$100.00	$123.03	$436.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $269.15 / $776.25	Professional	TC	$208.93	$269.15	$776.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $512.86 / $1,122.02	Professional		$331.13	$512.86	$1,122.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $173.78 / $338.84	Professional	26	$120.23	$173.78	$338.84
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $338.84 / $776.25	Professional	TC	$218.78	$338.84	$776.25
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $457.09 / $1,000.00	Professional		$302.00	$457.09	$1,000.00
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $154.88 / $309.03	Professional	26	$104.71	$154.88	$309.03
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $295.12 / $660.69	Professional	TC	$194.98	$295.12	$660.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $446.68 / $1,000.00	Professional		$331.13	$446.68	$1,000.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $138.04 / $295.12	Professional	26	$109.65	$138.04	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $316.23 / $691.83	Professional	TC	$218.78	$316.23	$691.83
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $316.23 / $524.81	Professional		$251.19	$316.23	$524.81
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $117.49 / $144.54	Professional	26	$93.33	$117.49	$144.54
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $199.53 / $380.19	Professional	TC	$158.49	$199.53	$380.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $457.09 / $776.25	Professional		$354.81	$457.09	$776.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $151.36 / $263.03	Professional	26	$107.15	$151.36	$263.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $371.54 / $691.83	Professional	TC	$245.47	$371.54	$691.83
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	26	$645.65	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $2,884.03 / $2,884.03	Professional		$2,454.71	$2,884.03	$2,884.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $758.58 / $851.14 / $851.14	Professional	26	$758.58	$851.14	$851.14
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,698.24 / $1,995.26 / $1,995.26	Professional	TC	$1,698.24	$1,995.26	$1,995.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $346.74 / $501.19	Professional		$151.36	$346.74	$501.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $436.52 / $977.24	Professional		$331.13	$436.52	$977.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $138.04 / $288.40	Professional	26	$109.65	$138.04	$288.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $302.00 / $660.69	Professional	TC	$213.80	$302.00	$660.69
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Professional		$1,174.90	$1,174.90	$1,174.90
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $346.74 / $346.74 / $346.74	Professional	26	$346.74	$346.74	$346.74
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $812.83 / $812.83 / $812.83	Professional	TC	$812.83	$812.83	$812.83
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $354.81 / $467.74	Professional		$263.03	$354.81	$467.74
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $398.11 / $1,047.13	Professional		$275.42	$398.11	$1,047.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $134.90 / $302.00	Professional	26	$89.13	$134.90	$302.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $257.04 / $741.31	Professional	TC	$186.21	$257.04	$741.31