Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $53.70 / $123.03	Professional		$42.66	$53.70	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $19.05 / $63.10	Professional	26	$14.13	$19.05	$63.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $35.48 / $75.86	Professional	TC	$26.92	$35.48	$75.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $104.71 / $229.09	Professional		$79.43	$104.71	$229.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $33.88 / $75.86	Professional	26	$25.70	$33.88	$75.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $70.79 / $158.49	Professional	TC	$54.95	$70.79	$158.49
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $74.13 / $147.91	Professional		$57.54	$74.13	$147.91
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $5.50 / $7.08 / $125.89	Professional	26	$5.50	$7.08	$125.89
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $67.61 / $144.54	Professional	TC	$52.48	$67.61	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $48.98 / $138.04	Professional		$32.36	$48.98	$138.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.49 / $47.86	Professional	26	$10.96	$15.49	$47.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $32.36 / $91.20	Professional	TC	$21.38	$32.36	$91.20
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $83.18 / $112.20	Professional		$53.70	$83.18	$112.20
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $27.54 / $37.15	Professional	26	$17.78	$27.54	$37.15
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $56.23 / $75.86	Professional	TC	$36.31	$56.23	$75.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $77.62 / $125.89	Professional		$64.57	$77.62	$125.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $31.62 / $40.74	Professional	26	$21.88	$31.62	$40.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $61.66 / $83.18	Professional	TC	$41.69	$61.66	$83.18
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	26	$158.49	$158.49	$158.49
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $549.54 / $549.54	Professional		$436.52	$549.54	$549.54
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $190.55 / $190.55	Professional	26	$158.49	$190.55	$190.55
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $354.81 / $354.81	Professional	TC	$281.84	$354.81	$354.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $67.61 / $181.97	Professional		$33.88	$67.61	$181.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $20.42 / $48.98	Professional	26	$11.22	$20.42	$48.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $39.81 / $104.71	Professional	TC	$21.88	$39.81	$104.71
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $281.84 / $281.84	Professional		$281.84	$281.84	$281.84
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $102.33 / $102.33	Professional	26	$102.33	$102.33	$102.33
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $177.83 / $177.83	Professional	TC	$177.83	$177.83	$177.83
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $93.33	Professional		$67.61	$67.61	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $47.86 / $177.83	Professional		$37.15	$47.86	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.98 / $67.61	Professional	26	$13.18	$16.98	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $30.90 / $117.49	Professional	TC	$24.55	$30.90	$117.49