Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.27 / $32.06 / $150.69	Facility	26	$29.27	$32.06	$150.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.79 / $118.61 / $362.37	Professional		$90.79	$118.61	$362.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.61 / $32.19 / $136.80	Professional	26	$24.61	$32.19	$136.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.65 / $83.10 / $288.10	Professional	TC	$61.65	$83.10	$288.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $110.50 / $163.00 / $403.04	Professional		$110.50	$163.00	$403.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.04 / $42.90 / $82.71	Professional	26	$32.04	$42.90	$82.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.80 / $116.47 / $325.88	Professional	TC	$74.80	$116.47	$325.88
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $148.51 / $244.16 / $585.72	Professional		$148.51	$244.16	$585.72
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.57 / $41.43 / $100.00	Professional	26	$32.57	$41.43	$100.00
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $123.17 / $205.26 / $487.87	Professional	TC	$123.17	$205.26	$487.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.43 / $39.43 / $39.43	Facility	26	$39.43	$39.43	$39.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.10 / $248.03 / $499.64	Professional		$161.10	$248.03	$499.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.28 / $38.01 / $75.53	Professional	26	$27.28	$38.01	$75.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.66 / $215.85 / $430.97	Professional	TC	$134.66	$215.85	$430.97
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $130.16 / $189.96 / $256.45	Professional		$130.16	$189.96	$256.45
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.33 / $39.58 / $53.43	Professional	26	$27.33	$39.58	$53.43
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.83 / $150.38 / $203.01	Professional	TC	$102.83	$150.38	$203.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.91 / $211.99 / $394.44	Professional		$162.91	$211.99	$394.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.92 / $49.32 / $82.98	Professional	26	$34.92	$49.32	$82.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $137.93 / $202.23 / $338.12	Professional	TC	$137.93	$202.23	$338.12
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $82.93 / $160.47 / $174.33	Facility	26	$82.93	$160.47	$174.33
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,219.73 / $1,341.64 / $1,341.64	Professional		$1,219.73	$1,341.64	$1,341.64
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $286.73 / $375.24 / $375.24	Professional	26	$286.73	$375.24	$375.24
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $936.06 / $1,090.58 / $1,120.47	Professional	TC	$936.06	$1,090.58	$1,120.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $181.33	Professional		$32.34	$32.34	$181.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $39.43 / $39.43 / $39.43	Facility	26	$39.43	$39.43	$39.43
Providence Facility/Professional Professional Modifier Low / Median / High Price $162.44 / $272.20 / $467.46	Professional		$162.44	$272.20	$467.46
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.58 / $37.70 / $69.48	Professional	26	$27.58	$37.70	$69.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $132.71 / $215.47 / $424.57	Professional	TC	$132.71	$215.47	$424.57
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $545.39 / $545.39 / $545.39	Professional		$545.39	$545.39	$545.39
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $84.87 / $84.87 / $84.87	Professional	26	$84.87	$84.87	$84.87
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $460.51 / $460.51 / $460.51	Professional	TC	$460.51	$460.51	$460.51
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $153.62 / $211.23 / $336.06	Professional		$153.62	$211.23	$336.06
United Facility/Professional Professional Modifier Low / Median / High Price $128.52 / $201.96 / $494.44	Professional		$128.52	$201.96	$494.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.00 / $31.50 / $76.38	Professional	26	$21.00	$31.50	$76.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.52 / $170.33 / $399.27	Professional	TC	$107.52	$170.33	$399.27