Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.43 / $116.70 / $238.00	Professional		$92.43	$116.70	$238.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.16 / $15.17 / $23.10	Professional	26	$13.16	$15.17	$23.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.68 / $101.46 / $203.43	Professional	TC	$78.68	$101.46	$203.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.45 / $113.89 / $336.21	Professional		$85.45	$113.89	$336.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.62 / $17.73 / $49.98	Professional	26	$14.62	$17.73	$49.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.83 / $92.67 / $293.55	Professional	TC	$70.83	$92.67	$293.55
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $66.90 / $95.57 / $132.32	Professional		$66.90	$95.57	$132.32
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.22 / $17.46 / $23.66	Professional	26	$12.22	$17.46	$23.66
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $54.67 / $78.09 / $112.07	Professional	TC	$54.67	$78.09	$112.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.99 / $143.35 / $420.90	Professional		$94.99	$143.35	$420.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.96 / $19.45 / $58.74	Professional	26	$13.96	$19.45	$58.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.08 / $122.00 / $392.15	Professional	TC	$80.08	$122.00	$392.15
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $13.37 / $17.67 / $195.48	Professional		$13.37	$17.67	$195.48
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.35 / $7.07 / $18.46	Professional	26	$5.35	$7.07	$18.46
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $8.02 / $10.60 / $177.03	Professional	TC	$8.02	$10.60	$177.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $124.88 / $151.03 / $264.30	Professional		$124.88	$151.03	$264.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.61 / $15.10 / $20.98	Professional	26	$13.61	$15.10	$20.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $118.12 / $144.85 / $196.08	Professional	TC	$118.12	$144.85	$196.08
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $42.29 / $100.00	Facility	26	$34.29	$42.29	$100.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $800.25 / $800.25 / $1,116.59	Professional		$800.25	$800.25	$1,116.59
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.38 / $135.38 / $135.38	Professional	26	$135.38	$135.38	$135.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $706.26 / $706.26 / $998.10	Professional	TC	$706.26	$706.26	$998.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $93.50 / $156.33 / $345.77	Professional		$93.50	$156.33	$345.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $19.22 / $43.91	Professional	26	$13.49	$19.22	$43.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $76.70 / $120.12 / $312.93	Professional	TC	$76.70	$120.12	$312.93
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $375.55 / $375.55 / $375.55	Professional		$375.55	$375.55	$375.55
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $49.68 / $49.68 / $49.68	Professional	26	$49.68	$49.68	$49.68
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $325.87 / $325.87 / $325.87	Professional	TC	$325.87	$325.87	$325.87
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $161.71 / $197.65 / $197.65	Professional		$161.71	$197.65	$197.65
United Facility/Professional Professional Modifier Low / Median / High Price $77.02 / $98.34 / $288.81	Professional		$77.02	$98.34	$288.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.61 / $14.19 / $34.10	Professional	26	$11.61	$14.19	$34.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.01 / $84.32 / $234.31	Professional	TC	$64.01	$84.32	$234.31