Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.41 / $53.20 / $339.34	Facility	26	$50.41	$53.20	$339.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.42 / $349.33 / $1,075.51	Professional		$295.42	$349.33	$1,075.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.73 / $53.09 / $257.61	Professional	26	$46.73	$53.09	$257.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $256.93 / $298.91 / $1,379.23	Professional	TC	$256.93	$298.91	$1,379.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $358.32 / $534.13 / $1,075.18	Professional		$358.32	$534.13	$1,075.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.14 / $74.06 / $149.03	Professional	26	$58.14	$74.06	$149.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $296.49 / $447.27 / $913.48	Professional	TC	$296.49	$447.27	$913.48
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $294.38 / $454.62 / $1,038.54	Professional		$294.38	$454.62	$1,038.54
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.06 / $68.31 / $150.05	Professional	26	$58.06	$68.31	$150.05
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $249.21 / $388.09 / $884.04	Professional	TC	$249.21	$388.09	$884.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $308.60 / $462.16 / $1,059.73	Professional		$308.60	$462.16	$1,059.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.50 / $73.08 / $161.66	Professional	26	$50.50	$73.08	$161.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $278.10 / $407.26 / $920.32	Professional	TC	$278.10	$407.26	$920.32
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $311.86 / $416.69 / $562.53	Professional		$311.86	$416.69	$562.53
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.78 / $61.31 / $82.77	Professional	26	$46.78	$61.31	$82.77
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $265.08 / $355.38 / $479.76	Professional	TC	$265.08	$355.38	$479.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $311.19 / $409.92 / $730.96	Professional		$311.19	$409.92	$730.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.42 / $73.45 / $128.80	Professional	26	$50.42	$73.45	$128.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $272.72 / $393.86 / $668.11	Professional	TC	$272.72	$393.86	$668.11
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $131.71 / $249.77 / $270.80	Facility	26	$131.71	$249.77	$270.80
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,141.04 / $2,141.04 / $2,645.93	Professional		$2,141.04	$2,141.04	$2,645.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $351.55 / $351.55 / $443.25	Professional	26	$351.55	$351.55	$443.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,789.49 / $1,789.49 / $2,202.67	Professional	TC	$1,789.49	$1,789.49	$2,202.67
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $32.34	Professional		$32.34	$32.34	$32.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $308.60 / $460.43 / $1,057.07	Professional		$308.60	$460.43	$1,057.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.11 / $73.09 / $159.09	Professional	26	$51.11	$73.09	$159.09
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $289.37 / $413.40 / $920.32	Professional	TC	$289.37	$413.40	$920.32
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,205.00 / $1,205.00 / $1,205.00	Professional		$1,205.00	$1,205.00	$1,205.00
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $190.75 / $190.75 / $190.75	Professional	26	$190.75	$190.75	$190.75
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,014.24 / $1,014.24 / $1,014.24	Professional	TC	$1,014.24	$1,014.24	$1,014.24
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $337.03 / $436.61 / $530.16	Professional		$337.03	$436.61	$530.16
United Facility/Professional Professional Modifier Low / Median / High Price $302.10 / $427.24 / $1,140.94	Professional		$302.10	$427.24	$1,140.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.17 / $62.70 / $163.83	Professional	26	$47.17	$62.70	$163.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $254.93 / $320.02 / $885.26	Professional	TC	$254.93	$320.02	$885.26