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 / $520.16	Facility	26	$140.00	$140.00	$520.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.05 / $475.00 / $2,245.57	Professional		$370.05	$475.00	$2,245.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.79 / $140.00 / $498.26	Professional	26	$88.79	$140.00	$498.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.35 / $335.00 / $972.99	Professional	TC	$259.35	$335.00	$972.99
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $407.15 / $700.00 / $1,192.39	Professional		$407.15	$700.00	$1,192.39
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.83 / $114.00 / $227.50	Professional	26	$80.83	$114.00	$227.50
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $525.85 / $625.45 / $1,050.00	Professional	50	$525.85	$625.45	$1,050.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $308.11 / $576.97 / $991.48	Professional	TC	$308.11	$576.97	$991.48
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $332.88 / $512.29 / $1,249.16	Professional		$332.88	$512.29	$1,249.16
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.87 / $108.35 / $258.33	Professional	26	$79.87	$108.35	$258.33
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $260.12 / $404.85 / $976.40	Professional	TC	$260.12	$404.85	$976.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.37 / $97.37 / $97.37	Facility	26	$97.37	$97.37	$97.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $296.69 / $572.60 / $1,146.83	Professional		$296.69	$572.60	$1,146.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.83 / $105.53 / $238.66	Professional	26	$51.83	$105.53	$238.66
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $507.23 / $507.23 / $580.67	Professional	50	$507.23	$507.23	$580.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $248.75 / $452.76 / $920.13	Professional	TC	$248.75	$452.76	$920.13
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $330.05 / $446.57 / $602.87	Professional		$330.05	$446.57	$602.87
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.31 / $93.95 / $126.83	Professional	26	$69.31	$93.95	$126.83
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $260.74 / $352.63 / $476.05	Professional	TC	$260.74	$352.63	$476.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $342.51 / $442.34 / $808.63	Professional		$342.51	$442.34	$808.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.43 / $112.74 / $216.09	Professional	26	$83.43	$112.74	$216.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $271.89 / $405.52 / $661.32	Professional	TC	$271.89	$405.52	$661.32
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $779.12 / $779.12 / $795.52	Facility	26	$779.12	$779.12	$795.52
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,018.44 / $3,045.40 / $3,045.40	Professional		$3,018.44	$3,045.40	$3,045.40
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $850.86 / $850.86 / $850.86	Professional	26	$850.86	$850.86	$850.86
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,546.60 / $2,573.94 / $2,616.37	Professional	TC	$2,546.60	$2,573.94	$2,616.37
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $269.43	Professional		$32.34	$32.34	$269.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $97.37 / $97.37 / $97.37	Facility	26	$97.37	$97.37	$97.37
Providence Facility/Professional Professional Modifier Low / Median / High Price $310.80 / $645.14 / $1,084.01	Professional		$310.80	$645.14	$1,084.01
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.79 / $103.28 / $228.98	Professional	26	$51.79	$103.28	$228.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $246.87 / $452.76 / $886.06	Professional	TC	$246.87	$452.76	$886.06
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,292.14 / $1,292.14 / $1,292.14	Professional		$1,292.14	$1,292.14	$1,292.14
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $292.41 / $292.41 / $292.41	Professional	26	$292.41	$292.41	$292.41
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $999.72 / $999.72 / $999.72	Professional	TC	$999.72	$999.72	$999.72
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $361.17 / $462.07 / $561.08	Professional		$361.17	$462.07	$561.08
United Facility/Professional Professional Modifier Low / Median / High Price $333.75 / $447.33 / $993.31	Professional		$333.75	$447.33	$993.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.52 / $95.29 / $217.25	Professional	26	$70.52	$95.29	$217.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $255.52 / $379.45 / $845.78	Professional	TC	$255.52	$379.45	$845.78