Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $502.70 / $4,932.00 / $16,713.00	Facility		$502.70	$4,932.00	$16,713.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.81 / $45.66 / $231.22	Facility	26	$43.81	$45.66	$231.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.13 / $224.71 / $683.78	Professional		$140.13	$224.71	$683.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.25 / $48.11 / $182.80	Professional	26	$40.25	$48.11	$182.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.17 / $112.89 / $288.66	Professional	TC	$94.17	$112.89	$288.66
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,787.00 / $4,539.00 / $9,381.00	Facility		$1,787.00	$4,539.00	$9,381.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $142.44 / $213.41 / $486.08	Professional		$142.44	$213.41	$486.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.35 / $69.81 / $155.26	Professional	26	$43.35	$69.81	$155.26
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.53 / $143.77 / $373.37	Professional	TC	$50.53	$143.77	$373.37
Blue Shield Facility/Professional Facility Modifier Low / Median / High Price $65.80 / $100.00 / $1,599.04	Facility		$65.80	$100.00	$1,599.04
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $110.11 / $178.20 / $434.29	Professional		$110.11	$178.20	$434.29
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.40 / $51.16 / $124.47	Professional	26	$37.40	$51.16	$124.47
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $93.68 / $127.83 / $313.33	Professional	TC	$93.68	$127.83	$313.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $132.41 / $275.77 / $632.22	Professional		$132.41	$275.77	$632.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.37 / $64.00 / $159.56	Professional	26	$41.37	$64.00	$159.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.93 / $200.00 / $502.52	Professional	TC	$89.93	$200.00	$502.52
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $59.20 / $89.58 / $261.37	Professional		$59.20	$89.58	$261.37
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.68 / $35.83 / $51.52	Professional	26	$23.68	$35.83	$51.52
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.52 / $53.75 / $209.86	Professional	TC	$35.52	$53.75	$209.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.57 / $233.31 / $411.97	Professional		$173.57	$233.31	$411.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.64 / $53.73 / $98.74	Professional	26	$38.64	$53.73	$98.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $142.47 / $208.79 / $402.22	Professional	TC	$142.47	$208.79	$402.22
Lucent Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $429.75 / $2,922.50	Facility		$55.00	$429.75	$2,922.50
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $101.27 / $181.86 / $190.52	Facility	26	$101.27	$181.86	$190.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,531.99 / $1,577.95 / $1,577.95	Professional		$1,531.99	$1,577.95	$1,577.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $684.00 / $907.84 / $907.84	Professional	26	$684.00	$907.84	$907.84
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,117.24 / $1,150.75 / $1,150.75	Professional	TC	$1,117.24	$1,150.75	$1,150.75
Providence Facility/Professional Facility Modifier Low / Median / High Price $173.57 / $243.44 / $357.77	Facility		$173.57	$243.44	$357.77
Providence Facility/Professional Professional Modifier Low / Median / High Price $138.33 / $283.52 / $540.50	Professional		$138.33	$283.52	$540.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $72.23 / $136.38	Professional	26	$42.66	$72.23	$136.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $89.93 / $201.09 / $450.68	Professional	TC	$89.93	$201.09	$450.68
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $545.73 / $545.73 / $545.73	Professional		$545.73	$545.73	$545.73
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $130.99 / $130.99 / $130.99	Professional	26	$130.99	$130.99	$130.99
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $414.74 / $414.74 / $414.74	Professional	TC	$414.74	$414.74	$414.74
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $59.20 / $104.51 / $242.21	Professional		$59.20	$104.51	$242.21
United Facility/Professional Facility Modifier Low / Median / High Price $548.00 / $1,551.00 / $6,920.00	Facility		$548.00	$1,551.00	$6,920.00
United Facility/Professional Professional Modifier Low / Median / High Price $124.47 / $204.07 / $503.32	Professional		$124.47	$204.07	$503.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.49 / $52.66 / $127.71	Professional	26	$33.49	$52.66	$127.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.70 / $155.74 / $439.15	Professional	TC	$89.70	$155.74	$439.15