Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $140.00 / $140.00 / $513.79	Facility	26	$140.00	$140.00	$513.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.50 / $475.00 / $2,277.82	Professional		$370.50	$475.00	$2,277.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.19 / $140.00 / $481.00	Professional	26	$90.19	$140.00	$481.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.99 / $335.00 / $931.29	Professional	TC	$259.99	$335.00	$931.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $407.02 / $700.00 / $1,252.07	Professional		$407.02	$700.00	$1,252.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.86 / $115.72 / $240.77	Professional	26	$79.86	$115.72	$240.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $311.64 / $585.66 / $1,008.99	Professional	TC	$311.64	$585.66	$1,008.99
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $332.31 / $511.49 / $1,245.94	Professional		$332.31	$511.49	$1,245.94
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.28 / $107.53 / $260.83	Professional	26	$79.28	$107.53	$260.83
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $260.12 / $404.85 / $975.27	Professional	TC	$260.12	$404.85	$975.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.98 / $575.13 / $1,161.74	Professional		$295.98	$575.13	$1,161.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $101.48 / $237.92	Professional	26	$51.23	$101.48	$237.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $249.71 / $470.15 / $933.02	Professional	TC	$249.71	$470.15	$933.02
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $331.39 / $449.08 / $606.26	Professional		$331.39	$449.08	$606.26
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.59 / $93.70 / $126.50	Professional	26	$69.59	$93.70	$126.50
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $261.80 / $355.38 / $479.76	Professional	TC	$261.80	$355.38	$479.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $344.33 / $444.67 / $812.75	Professional		$344.33	$444.67	$812.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.12 / $112.44 / $215.51	Professional	26	$83.12	$112.44	$215.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $274.02 / $408.69 / $666.47	Professional	TC	$274.02	$408.69	$666.47
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $776.00 / $776.00 / $789.92	Facility	26	$776.00	$776.00	$789.92
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,014.38 / $3,039.70 / $3,039.70	Professional		$3,014.38	$3,039.70	$3,039.70
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $597.70 / $597.70 / $683.48	Professional	26	$597.70	$597.70	$683.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,544.17 / $2,573.94 / $2,613.88	Professional	TC	$2,544.17	$2,573.94	$2,613.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $269.12	Professional		$32.34	$32.34	$269.12
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $310.44 / $662.46 / $1,088.11	Professional		$310.44	$662.46	$1,088.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.92 / $97.87 / $235.23	Professional	26	$48.92	$97.87	$235.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $228.96 / $475.10 / $900.87	Professional	TC	$228.96	$475.10	$900.87
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,289.83 / $1,289.83 / $1,289.83	Professional		$1,289.83	$1,289.83	$1,289.83
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $288.91 / $288.91 / $288.91	Professional	26	$288.91	$288.91	$288.91
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,000.92 / $1,000.92 / $1,000.92	Professional	TC	$1,000.92	$1,000.92	$1,000.92
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $363.20 / $463.94 / $563.35	Professional		$363.20	$463.94	$563.35
United Facility/Professional Professional Modifier Low / Median / High Price $333.14 / $446.20 / $1,021.14	Professional		$333.14	$446.20	$1,021.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.69 / $92.92 / $224.73	Professional	26	$69.69	$92.92	$224.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $255.83 / $379.91 / $1,018.58	Professional	TC	$255.83	$379.91	$1,018.58