Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.54 / $393.75 / $1,183.93	Professional		$245.54	$393.75	$1,183.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.13 / $42.60 / $127.95	Professional	26	$35.13	$42.60	$127.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $271.29 / $357.90 / $1,011.02	Professional	TC	$271.29	$357.90	$1,011.02
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $388.32 / $498.73 / $1,149.84	Professional		$388.32	$498.73	$1,149.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.84 / $54.86 / $119.62	Professional	26	$40.84	$54.86	$119.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $347.47 / $441.27 / $1,028.56	Professional	TC	$347.47	$441.27	$1,028.56
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $352.98 / $504.25 / $1,189.05	Professional		$352.98	$504.25	$1,189.05
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.65 / $54.58 / $127.85	Professional	26	$38.65	$54.58	$127.85
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $314.79 / $449.70 / $1,052.09	Professional	TC	$314.79	$449.70	$1,052.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $220.00 / $322.12 / $1,110.63	Professional		$220.00	$322.12	$1,110.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.24 / $29.76 / $105.51	Professional	26	$24.24	$29.76	$105.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $196.38 / $291.77 / $1,020.77	Professional	TC	$196.38	$291.77	$1,020.77
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $307.14 / $546.16 / $737.33	Professional		$307.14	$546.16	$737.33
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.38 / $72.06 / $270.27	Professional	26	$53.38	$72.06	$270.27
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.86 / $492.79 / $665.27	Professional	TC	$36.86	$492.79	$665.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $404.98 / $491.17 / $812.12	Professional		$404.98	$491.17	$812.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $64.06 / $80.09	Professional	26	$42.70	$64.06	$80.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $363.98 / $588.57 / $739.19	Professional	TC	$363.98	$588.57	$739.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $114.94 / $213.45 / $233.75	Facility	26	$114.94	$213.45	$233.75
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,779.34 / $2,779.34 / $3,419.93	Professional		$2,779.34	$2,779.34	$3,419.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $306.82 / $306.82 / $376.73	Professional	26	$306.82	$306.82	$376.73
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,481.83 / $2,481.83 / $3,043.20	Professional	TC	$2,481.83	$2,481.83	$3,043.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $46.29 / $339.99 / $386.27	Professional		$46.29	$339.99	$386.27
Providence Facility/Professional Professional Modifier Low / Median / High Price $225.34 / $534.45 / $1,240.45	Professional		$225.34	$534.45	$1,240.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.69 / $31.32 / $139.25	Professional	26	$24.69	$31.32	$139.25
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $199.06 / $340.26 / $1,132.68	Professional	TC	$199.06	$340.26	$1,132.68
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,696.61 / $1,696.61 / $1,696.61	Professional		$1,696.61	$1,696.61	$1,696.61
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $185.58 / $185.58 / $185.58	Professional	26	$185.58	$185.58	$185.58
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,511.03 / $1,511.03 / $1,511.03	Professional	TC	$1,511.03	$1,511.03	$1,511.03
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $441.82 / $441.82 / $607.51	Professional		$441.82	$441.82	$607.51
United Facility/Professional Professional Modifier Low / Median / High Price $250.88 / $330.62 / $1,026.28	Professional		$250.88	$330.62	$1,026.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.46 / $31.58 / $125.37	Professional	26	$28.46	$31.58	$125.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $220.57 / $299.55 / $926.88	Professional	TC	$220.57	$299.55	$926.88