Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.37 / $113.95 / $605.57	Facility	26	$110.37	$113.95	$605.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $312.81 / $453.57 / $1,582.00	Professional		$312.81	$453.57	$1,582.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.56 / $117.64 / $444.36	Professional	26	$101.56	$117.64	$444.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $150.02 / $283.67 / $326.69	Professional	52	$150.02	$283.67	$326.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $198.49 / $231.56 / $569.91	Professional	TC	$198.49	$231.56	$569.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $303.58 / $468.97 / $1,048.83	Professional		$303.58	$468.97	$1,048.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $107.44 / $159.37 / $306.82	Professional	26	$107.44	$159.37	$306.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $195.08 / $307.02 / $754.57	Professional	TC	$195.08	$307.02	$754.57
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $210.90 / $346.25 / $843.52	Professional		$210.90	$346.25	$843.52
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $82.68 / $114.95 / $282.94	Professional	26	$82.68	$114.95	$282.94
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $136.09 / $226.25 / $563.04	Professional	TC	$136.09	$226.25	$563.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $322.18 / $480.38 / $1,283.70	Professional		$322.18	$480.38	$1,283.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.28 / $138.47 / $407.04	Professional	26	$106.28	$138.47	$407.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.87 / $336.48 / $870.82	Professional	TC	$213.87	$336.48	$870.82
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $209.68 / $314.52 / $524.94	Professional		$209.68	$314.52	$524.94
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.58 / $112.19 / $134.63	Professional	26	$77.58	$112.19	$134.63
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.52 / $321.08 / $390.31	Professional	TC	$158.52	$321.08	$390.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $352.51 / $472.99 / $833.27	Professional		$352.51	$472.99	$833.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $100.97 / $140.44 / $258.04	Professional	26	$100.97	$140.44	$258.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $265.10 / $388.54 / $731.84	Professional	TC	$265.10	$388.54	$731.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $240.28 / $463.23 / $498.13	Facility	26	$240.28	$463.23	$498.13
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,444.00 / $2,698.08 / $2,846.03	Professional		$2,444.00	$2,698.08	$2,846.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $752.32 / $770.56 / $835.28	Professional	26	$752.32	$770.56	$835.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,747.81 / $1,927.52 / $2,010.75	Professional	TC	$1,747.81	$1,927.52	$2,010.75
Providence Facility/Professional Professional Modifier Low / Median / High Price $326.58 / $503.30 / $1,061.93	Professional		$326.58	$503.30	$1,061.93
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $107.57 / $138.47 / $331.30	Professional	26	$107.57	$138.47	$331.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $213.54 / $335.61 / $795.32	Professional	TC	$213.54	$335.61	$795.32
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,180.45 / $1,180.45 / $1,180.45	Professional		$1,180.45	$1,180.45	$1,180.45
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $342.46 / $342.46 / $342.46	Professional	26	$342.46	$342.46	$342.46
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $837.99 / $837.99 / $837.99	Professional	TC	$837.99	$837.99	$837.99
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $209.68 / $356.45 / $486.39	Professional		$209.68	$356.45	$486.39
United Facility/Professional Professional Modifier Low / Median / High Price $280.00 / $408.09 / $1,156.48	Professional		$280.00	$408.09	$1,156.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $84.56 / $131.93 / $344.56	Professional	26	$84.56	$131.93	$344.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $188.46 / $279.95 / $816.35	Professional	TC	$188.46	$279.95	$816.35