Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $223.87 / $524.81	Facility	26	$141.25	$223.87	$524.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $501.19 / $2,187.76	Professional		$346.74	$501.19	$2,187.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $501.19	Professional	26	$85.11	$141.25	$501.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $354.81 / $1,096.48	Professional	TC	$257.04	$354.81	$1,096.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $741.31 / $1,318.26	Professional		$489.78	$741.31	$1,318.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $125.89 / $251.19	Professional	26	$89.13	$125.89	$251.19
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $501.19 / $616.60 / $1,071.52	Professional	50	$501.19	$616.60	$1,071.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $616.60 / $1,071.52	Professional	TC	$398.11	$616.60	$1,071.52
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $691.83 / $1,258.93	Professional		$478.63	$691.83	$1,258.93
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $144.54 / $257.04	Professional	26	$104.71	$144.54	$257.04
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $537.03 / $1,023.29	Professional	TC	$371.54	$537.03	$1,023.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $575.44 / $1,096.48	Professional		$302.00	$575.44	$1,096.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $109.65 / $208.93	Professional	26	$60.26	$109.65	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $446.68 / $870.96	Professional	TC	$251.19	$446.68	$870.96
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $446.68 / $616.60	Professional		$331.13	$446.68	$616.60
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $95.50 / $128.82	Professional	26	$69.18	$95.50	$128.82
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $354.81 / $478.63	Professional	TC	$263.03	$354.81	$478.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $416.87 / $870.96	Professional		$331.13	$416.87	$870.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $109.65 / $186.21	Professional	26	$81.28	$109.65	$186.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $371.54 / $676.08	Professional	TC	$295.12	$371.54	$676.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,019.95 / $3,019.95 / $3,019.95	Professional		$3,019.95	$3,019.95	$3,019.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $851.14 / $851.14 / $851.14	Professional	26	$851.14	$851.14	$851.14
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,570.40 / $2,570.40 / $2,630.27	Professional	TC	$2,570.40	$2,570.40	$2,630.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $102.33 / $354.81	Professional		$32.36	$102.33	$354.81
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $602.56 / $977.24	Professional		$309.03	$602.56	$977.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $102.33 / $194.98	Professional	26	$52.48	$102.33	$194.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $436.52 / $812.83	Professional	TC	$245.47	$436.52	$812.83
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $1,288.25	Professional		$1,288.25	$1,288.25	$1,288.25
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $295.12 / $295.12 / $295.12	Professional	26	$295.12	$295.12	$295.12
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Professional	TC	$1,000.00	$1,000.00	$1,000.00
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $426.58 / $562.34	Professional		$331.13	$426.58	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $446.68 / $912.01	Professional		$331.13	$446.68	$912.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $87.10 / $186.21	Professional	26	$66.07	$87.10	$186.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $371.54 / $724.44	Professional	TC	$257.04	$371.54	$724.44