Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.62 / $64.87 / $344.27	Facility	26	$58.62	$64.87	$344.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $382.41 / $451.63 / $1,298.93	Professional		$382.41	$451.63	$1,298.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.20 / $64.48 / $245.71	Professional	26	$53.20	$64.48	$245.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $330.06 / $384.10 / $718.15	Professional	TC	$330.06	$384.10	$718.15
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $374.14 / $524.12 / $1,108.02	Professional		$374.14	$524.12	$1,108.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.11 / $84.42 / $171.42	Professional	26	$56.11	$84.42	$171.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $292.73 / $443.30 / $920.89	Professional	TC	$292.73	$443.30	$920.89
Blue Shield Facility/Professional Professional Modifier Low / Median / High Price $284.27 / $426.94 / $1,015.14	Professional		$284.27	$426.94	$1,015.14
Blue Shield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.88 / $52.37 / $125.24	Professional	26	$37.88	$52.37	$125.24
Blue Shield Facility/Professional Professional Modifier TC Low / Median / High Price $248.93 / $375.33 / $885.11	Professional	TC	$248.93	$375.33	$885.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $438.47 / $667.56 / $1,300.85	Professional		$438.47	$667.56	$1,300.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.04 / $92.44 / $166.65	Professional	26	$61.04	$92.44	$166.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $375.51 / $581.88 / $1,143.30	Professional	TC	$375.51	$581.88	$1,143.30
Contra Costa Health Facility/Professional Professional Modifier Low / Median / High Price $195.72 / $297.88 / $790.88	Professional		$195.72	$297.88	$790.88
Contra Costa Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.00 / $68.50 / $86.88	Professional	26	$63.00	$68.50	$86.88
Contra Costa Health Facility/Professional Professional Modifier TC Low / Median / High Price $127.22 / $193.62 / $705.82	Professional	TC	$127.22	$193.62	$705.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $435.66 / $551.94 / $1,015.00	Professional		$435.66	$551.94	$1,015.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.31 / $63.66 / $131.81	Professional	26	$52.31	$63.66	$131.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $403.63 / $522.83 / $914.95	Professional	TC	$403.63	$522.83	$914.95
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $133.12 / $416.00 / $416.00	Facility	26	$133.12	$416.00	$416.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,713.40 / $3,905.69 / $3,905.69	Professional		$3,713.40	$3,905.69	$3,905.69
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $617.51 / $617.51 / $617.51	Professional	26	$617.51	$617.51	$617.51
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,576.06 / $3,683.35 / $3,683.35	Professional	TC	$3,576.06	$3,683.35	$3,683.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $32.34 / $585.48	Professional		$32.34	$32.34	$585.48
Providence Facility/Professional Professional Modifier Low / Median / High Price $460.62 / $745.57 / $1,183.61	Professional		$460.62	$745.57	$1,183.61
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.93 / $96.31 / $159.69	Professional	26	$61.93	$96.31	$159.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $380.91 / $600.29 / $1,143.30	Professional	TC	$380.91	$600.29	$1,143.30
Sutter Health Plus Facility/Professional Professional Modifier Low / Median / High Price $1,393.92 / $1,393.92 / $1,393.92	Professional		$1,393.92	$1,393.92	$1,393.92
Sutter Health Plus Facility/Professional Professional Modifier 26 Low / Median / High Price $193.16 / $193.16 / $193.16	Professional	26	$193.16	$193.16	$193.16
Sutter Health Plus Facility/Professional Professional Modifier TC Low / Median / High Price $1,200.76 / $1,200.76 / $1,200.76	Professional	TC	$1,200.76	$1,200.76	$1,200.76
The Alliance Facility/Professional Professional Modifier Low / Median / High Price $293.58 / $487.54 / $651.50	Professional		$293.58	$487.54	$651.50
United Facility/Professional Professional Modifier Low / Median / High Price $327.88 / $480.11 / $1,211.01	Professional		$327.88	$480.11	$1,211.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.04 / $76.59 / $167.99	Professional	26	$47.04	$76.59	$167.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $270.81 / $401.20 / $1,041.36	Professional	TC	$270.81	$401.20	$1,041.36